Intravenous dexmedetomidine versus esmolol for attenuation of haemodynamic response to endotracheal extubation: A randomized double-blind study

Background and Aim: Tracheal extubation is a crucial step of general anaesthesia which is associated with intense airway and hemodynamic responses secondary to activation of mechanoreceptors in larynx. The present study aims to compare the efficacy of intravenously administered dexmedetomidine and esmolol in attenuating the hemodynamic response to endotracheal extubation. Materials and Method: This prospective, randomized, double-blind study was conducted in 80 ASA I-II patients of 18-60 years undergoing elective surgery under general anaesthesia. They were randomly divided into two groups of forty each. Anticipated ten minutes before the extubation Group D received intravenous dexmedetomidine 0.5 µg/kg diluted in 10 ml normal saline and Group E received 10 ml of normal saline. Two min before extubation Group D received 10 ml normal saline and Group E received esmolol bolus dose 1 mg/kg diluted in 10 ml normal saline. Heart rate, systolic blood pressure, diastolic blood pressure, mean blood pressure, extubation and emergence time, Ramsay sedation score and adverse events were recorded. Results: Mean heart rate was significantly lower in group D from 5 min of drug administration till 20 min post extubation as compared to group E. Mean systolic blood pressure, diastolic blood pressure and mean blood pressure were significantly lower in group D as compared to group E from 8 min after administration of drug till 20 min of post extubation ( p <0.05). Emergence time, extubation time and adverse events were comparable in both the groups ( p >0.05). Delayed emergence was observed in 2 patients in group D. More number of patients in group D were sedated. Conclusion: IV dexmedetomidine is better in attenuating haemodynamic response to endotracheal extubation than esmolol because of comparatively stable haemodynamics, comparable emergence and extubation time, conscious sedation, less postoperative cough and agitation.