Comparison of the Effects of Intravenous Dexmedetomidine and Remifentanil in Attenuating the Cardiovascular Response to Extubation in Patients Under General Anesthesia: A Randomized Clinical Trial

<b>Background:</b> Considering the importance of hemodynamic stability during tracheal tube removal in patients undergoing surgery with general anesthesia. This study was designed to evaluate and compare the impacts of intravenous dexmedetomidine and remifentanil on mitigating the cardiovascular responses associated with extubation in individuals receiving general anesthesia. <b>Methods:</b> In this clinical study, a cohort of 90 patients scheduled for surgical procedures under general anesthesia was evenly divided into three groups of 30, receiving dexmedetomidine (0.7 μg/kg), remifentanil (0.3 μg/kg), or a placebo of normal saline. Hemodynamic metrics, such as heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP), were assessed at baseline, prior to extubation, and at intervals of 1, 3, 5, and 10 min following extubation. <b>Results:</b> At 1-10 min postextubation, the control group (C) had a higher HR than the dexmedetomidine (D) and remifentanil (R) groups (<i>p</i> < 0.001), there was no difference in HR between the D and R groups (<i>p</i>=0.57). There was a significant difference in SBP between D and C groups (<i>p</i>=0.09) and between D and C groups (<i>p</i>=0.047). No significant differences in DBP were found among the groups (<i>p</i> > 0.0.5). There was a notable difference in MAP changes between Groups D and C (<i>p</i>=0.010), but there were no differences between Groups D and R (<i>p</i>=0.14) and R and C (<i>p</i>=0.84). In addition, the incidence of tachycardia in Group C was significantly higher than that in other groups (<i>p</i> < 0.001). In addition, the incidence of tachycardia in Group C was significantly higher than that in other groups (<i>p</i> < 0.001). <b>Conclusion:</b> Administering dexmedetomidine at a dosage of 0.7 μg/kg enhances hemodynamic stability during extubation and decreases the occurrence of hemodynamic disturbances and coughing when compared to remifentanil at 0.3 μg/kg and the control group. Therefore, it is regarded as the optimal option for alleviating cardiovascular responses during extubation. <b>Trial Registration:</b> Iranian Clinical Trials Registry: IRCT20200825048515N74.