Santhosh Govinda Rao1, Mathikere Boregowda Sudarshan2, Velagalaburrre Yalappa Srinivas3

Complications during extubation are 3 times more than the intubation. A clinical study compares the efficacy of dexmedetomidine with esmolol in attenuating extubation stress responses in patients undergoing procedures under general anaesthesia.
After institutional ethical committee clearance and informed consent, 90 patients of either sex between 18-60 years belonging to ASA Class I posted for elective surgical procedure under general anaesthesia were enrolled in the study. The study population was randomly divided into three groups of 30 each. Group DX received dexmedetomidine 0.005 mg/kg, Group EX received esmolol 1.5 mg/kg and Group CX received saline placebo intravenously. Various parameters regarding haemodynamics were evaluated just before, during the process and immediately after extubation. Two time intervals- one between stopping of nitrous oxide to eye opening and the other between stopping of nitrous oxide to extubation were noted. Various side effects such as desaturation, bronchospasm, laryngospasm and post-extubation cough too were recorded simultaneously. A 5-point scale was used to rate quality of extubation and Ramsay sedation scale was used to rate sedation.
Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) were increased in all the groups at extubation, but was statistically and clinically significant only in control group (p <0.001). Time to extubation and eye opening were prolonged in Group DX (p <0.001). Incidence of coughing was 10% in Group DX when compared to 23% and 26% in Group CX and group EX respectively, which was significant (p <0.001). Incidence of hypotension was 3 out of 30 in Group DX, 4 out of 30 in Group EX compared to none in Group CX, which was significant. Agitation was high in Group CX-30% and Group EX-26% than in group DX- p <0.001. The patients of dexmedetomidine group were more sedated for 30 minutes post extubation. Extubation quality was better in dexmedetomidine group.
Both the drugs attenuate haemodynamic response to extubation, whereas dexmedetomidine attenuates airway reflexed during emergence from general anaesthesia and facilitates smooth extubation without undue sedation.