Effects of dexmedetomidine on hemodynamics during endotracheal extubation in low- and high-risk patients

Background and objectives Tracheal extubation is a high-risk procedure in anesthesia and critical care. Complications may relate to exaggerated laryngeal reflexes such as breath holding, coughing, and bucking and are associated with increased arterial blood pressure, venous pressure, and heart rate (HR). Dexmedetomidine is highly selective alpha two agonist, having sedative, analgesic, sympatholytic, and anxiolytic effects that blunt many of the cardiovascular responses during extubation. Aim This study aims to response to extubation in low-risk and at-risk patients receiving dexmedetomidine. Patients and methods This study was carried out in the Maxillofacial Surgery Department Alexandria Main University Hospital on 40 ASA status I and II middle-aged patients, scheduled for elective surgical procedures with exclusion criteria: diabetes mellitus, bronchial asthma, laryngeal and vocal cord problems and hypersensitivity to the drug used. Patients were categorized into two equal groups (twenty each) according to the technique used for extubation. Group I: Low-risk extubation: Patients with normal airways, routine extubation was conducted. Group II: At-risk extubation, where extubation was planned over a tube exchange catheter. Measurements: demographic measurements, type and duration of operation, hemodynamic measurements, Oxygen saturation. Main results In both groups, it was found that the HR, systolic arterial blood pressure, and diastolic arterial blood pressure showed a nonsignificant decrease 1 min after administration of dexmedetomidine and increased significantly at extubation as compared with the base line values. HR group II values was higher than group I at 1 min after dexmedetomidine administration, 1, 3, 5, 20, and 60 min after extubation; whereas systolic arterial blood pressure values in group II were higher than group I at extubation and 1, 3, 5, and 20 min after extubation. Diastolic arterial blood pressure values at 1, 3, 5, and 120 min after extubation were higher in group II than in group I. there is no difference between two groups regarding quality of extuabation or incidence of desaturation. Conclusion Intravenous administration of dexmedetomidine before extubation was an effective and practical prophylactic method for suppressing the hypertensive and tachycardic responses to tracheal extubation.