Comparison of the Effects of Dexmedetomidine Versus Lidocaine in Blunting the Hemodynamic Response to Tracheal Extubation in Patients Undergoing Craniotomy

Background Tracheal extubation following neurosurgical procedures is commonly associated with sympathetic stimulation, leading to tachycardia and hypertension. Such hemodynamic fluctuations may increase intracranial pressure (ICP) and adversely affect cerebral perfusion in patients undergoing craniotomy. Various pharmacological agents have been used to attenuate these responses; however, the comparative effectiveness of dexmedetomidine and lidocaine during tracheal extubation remains an area of clinical interest. Objectives The objective of this study is to compare the effectiveness of dexmedetomidine and lidocaine in attenuating the hemodynamic response to tracheal extubation in patients undergoing craniotomy. Study design, setting, and methodology This was a prospective comparative study conducted in the neurosurgery operating theatres of Civil Hospital Karachi, Karachi, Pakistan. A total of 60 patients undergoing craniotomy were included and divided into two groups (n = 30 each). Group A received intravenous dexmedetomidine (0.5 µg/kg), and Group B received intravenous lidocaine (1.5 mg/kg) prior to extubation. Hemodynamic parameters, including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP), were recorded at baseline and at 0, 1, 3, 5, and 10 minutes after extubation. Postoperative pain score, sedation score, and extubation quality were also assessed. Data were analyzed using IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, NY, USA), and a p-value ≤ 0.05 was considered statistically significant. Results Baseline demographic characteristics were comparable between the two groups. Hemodynamic parameters remained similar during the early post-extubation period; however, significant increases in HR, SBP, DBP, and MAP were observed in the lidocaine group at 5 and 10 minutes after extubation (p < 0.05). Additionally, the dexmedetomidine group demonstrated significantly lower pain scores (1.57 ± 0.62 vs 3.07 ± 1.98), better extubation quality (1.00 ± 0.78 vs 2.10 ± 0.84), and lower sedation scores (1.43 ± 0.56 vs 2.17 ± 0.69), compared with the lidocaine group (p = 0.0005). Conclusion Dexmedetomidine was more effective than lidocaine in attenuating the hemodynamic response to tracheal extubation and provided better postoperative recovery outcomes in patients undergoing craniotomy.