Effect of Dexmedetomidine on Hemodynamic and Recovery Responses during Tracheal Extubation

Abstract

Background: Extubation, the transition from controlled anesthesia to spontaneous breathing, is a critical perioperative phase associated with risks such as laryngospasm, bronchospasm, hemodynamic instability, desaturation, and arrhythmias. Smooth extubation, defined as the absence of coughing, straining, or airway obstruction, is vital for patient safety. Dexmedetomidine, a selective α2-adrenergic agonist with sedative, analgesic, and sympatholytic properties, provides stable conditions without respiratory depression, making it a promising agent for extubation. This study aimed to assess the impact of dexmedetomidine on hemodynamic stability and recovery responses during tracheal extubation. Objectives included evaluating the quality of extubation, the level of postoperative sedation, and drug-related adverse effects.

Methods: In this prospective, double-blind, randomized trial, 60 ASA I/II adult patients undergoing elective surgery under general anesthesia were allocated into two groups (n=30 each). Group D received dexmedetomidine 0.5 mcg/kg in 100 ml saline over 15 minutes, and Group N received 100 ml saline before extubation. Heart rate, blood pressure, mean arterial pressure, and saturation were recorded perioperatively. Extubation was assessed using the Extubation Quality Score (EQS), sedation with the Ramsay Sedation Score (RSS), and adverse events were documented.

Results: Both groups were demographically comparable. Group D had significantly lower hemodynamic responses, higher sedation (RSS 2.08 vs. 1.02; p<0.0001), and smoother extubation (EQS 1.18 vs. 1.84; p=0.0012). Bradycardia and sedation were more frequent in Group D, while nausea and vomiting occurred only in Group N.

Conclusion: Dexmedetomidine 0.5 mcg/kg before extubation improved hemodynamic stability, sedation, and extubation quality, though careful monitoring is required for bradycardia and hypotension