COMPARISON OF DEXMEDETOMIDINE AND FENTANYL ON AIRWAY RESPONSE AND HEMODYNAMICS DURING TRACHEAL EXTUBATION

Background: Extubation is associated with various circulatory and airway responses. Various pharmacological measures including fentanyl and dexmedetomidine have been used to blunt the reflex without compromising the spontaneous respiration. In this study we wanted to compare dexmedetomidine and fentanyl on airway response, smoothness of extubation and hemodynamic changes. Methodology: A total of 68 patients undergoing surgery under general anesthesia with endotracheal intubation, were randomized into two groups. Group A received dexmedetomidine 0.5 mcg/kg and Group B received 1 mcg/kg of fentanyl with the start of skin suturing over a period of 10 minutes via syringe pump. Airway reflex during suction and smoothness of extubation were assessed. Level of sedation during suction, extubation and then every 5 minutes post extubation for 15 minutes were recorded. Hemodynamic parameters were assessed every 5 minutes with start of test solution till extubation and then every 5 minutes for 15 minutes. Results: A total of 68 patients were evaluated in the study. In dexmedetomidine group, 67.6% of patients had no cough on extubation while in fentanyl group 35.3% of patients had no cough on extubation  which was statistically significant (p value 0.015). Mean heart rate during extubation increased in both the groups but the increase was 39% in Group B and 11% in Group A from baseline which was statistically significant (p value < 0.001). There was rise in mean systolic and mean arterial pressure during extubation in both the groups but the increase was significantly higher in fentanyl group. Patients in dexmedetomidine group were more sedated but there were no any adverse events. Conclusion: With the results obtained from the study, it is concluded that dexmedetomidine 0.5 mcg/kg over 10 minutes before extubation is effective in alleviating airway response and haemodynamics compared to fentanyl 1 mcg/kg.