INTRAVENOUS DEXMEDETOMIDINE AT EXTUBATION TIME: A SUPERIOR CHOICE TO INTRAVENOUS DEXAMETHASONE IN ENT SURGERY
Abstract
Background: In ENT (Ear, Nose, Throat) surgery, smooth emergence and extubation are crucial for patient comfort and reducing postoperative complications. ENT surgery requires precise anaesthetic management to ensure patient comfort, minimize complications, and facilitate smooth recovery. IV (Intravenous) Dexmedetomidine and IV Dexamethasone are commonly used during extubation, but their effects differ significantly. This article compares IV Dexmedetomidine and IV Dexamethasone at extubation time, highlighting the benefits of Dexmedetomidine in ENT surgery. Methods: A total of 86 patients undergoing elective ENT surgeries were included in the study. 43 patients were included in IV Dexamethasone group (Group A) while 43 patients were in IV Dexmedetomidine group (Group B). General anaesthesia was given using induction agent Propofol and muscle relaxant Atracurium. Before extubation time, single dose of IV Dexamethasone was given @ 0.1 mg/kg while IV Dexmedetomidine was given at 1 mcg/kg. Immediately after extubation, hemodynamic parameters (mean arterial pressure and heart rate) were noted at 0, 5, 10, 20 and 30 minutes. Postoperative complications such as nausea and vomiting (PONV) and respiratory complications (coughing, bucking on tracheal tube, laryngospasm) were also noted. Pain score was noted using visual analogue pain score post- extubation and frequency of pain killers demanded postoperatively by the patients in 24 hours was also noted (VAS score >4). Results: Mean arterial pressure in Group A at 0,10,20 and 30 minutes post extubation was 90.907±0.83, 88.511±0.50, 84.627±6.12 and 82.767±1.17 mmHg respectively as compared to 97.186±0.98, 103.627±1.57, 109.581±1.19 and 94.069±1.12 mmHg respectively in Group B (p<0.05). Mean heart rate at 0,10,20 and 30 minutes post extubation in Group A was 75.325±1.06, 78.418±7.09, 85.00±0.78 and 84.325±1.65 beats/minute respectively versus 95.116±2.59, 102.720±1.07, 92.465±1.46 and 85.534±2.10 beats/minute respectively in Group B with statistically significant p-value (p<0.05). Respiratory complications were reduced in Group A (p<0.05) while Group B patients experienced little postoperative nausea and vomiting (p<0.05). Postoperatively, lesser frequency of painkiller demands was made by Group A patients in 24 hours (p<0.05). Conclusion: In general, single dose of Dexmedetomidine given before extubation in ENT surgery reduces respiratory complications, provides adequate analgesia and resists sudden hemodynamic alterations by maintaining the blood pressure and heart rate, thus, minimizing complications postoperatively.
References
1. Patnaik S, Singh S, Vivekanand D, Singh TP, Saurav. Evaluation of quality of recovery score in mothers and neonatal outcome assessment after surgery using preoperative dexamethasone for caesarean section. Med J Armed Forces India 2021;77(2):170–4.
2. Sharma SK, Singh S, Paul D, Ameta N, Taank P, Singh T. Effect of dexamethasone with granisetron or ondansetron for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic gynaecological surgery. Int J Res Med Sci 2020;8(4):1331–5.
3. Waldron NH, Jones CA, Gan TJ, Allen TK, Habib AS. Impact of perioperative dexamethasone on postoperative analgesia and side effects: systematic review and meta analysis. Br J Anaesth 2013;110(2):191–200.
4. De Oliveira GS, Almeida MD, Benzon HT, McCarthy RJ. Perioperative single dose systemic dexamethasone for postoperative pain: meta analysis of randomized controlled trials. Anesthesiology 2011;115(3):575–88.
5. Bisgaard T, Klarskov B, Kehlet H, Rosenberg J. Preoperative dexamethasone improves surgical outcome after laparoscopic cholecystectomy: randomized double blind placebo controlled trial. Ann Surg 2003;238(5):651–660.
6. Bakri MH, Ismail EA, Ibrahim A. Comparison of dexmedetomidine and dexamethasone for prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. Korean J Anesthesiol 2015;68(3):254–60.
7. Wang X, Liu N, Chen J, Xu Z, Wang F, Ding C. Effect of intravenous dexmedetomidine during general anesthesia on acute postoperative pain in adults: systematic review and meta analysis of randomized controlled trials. Clin J Pain 2018;34(12):1180–91.
8. Li B, Li Y, Tian S, Wang H, Wu H, Zhang A, Gao C. Anti inflammatory effects of perioperative dexmedetomidine administered as adjunct to general anesthesia: meta analysis. Sci Rep 2015;5:12342.
9. Lawrence CJ, De Lange S. Effects of a single pre operative dexmedetomidine dose on isoflurane requirements and perioperative hemodynamic stability. Anaesthesia 1997;52(8):736–44.
10. Scheinin B, Lindgren L, Randell T, Scheinin H, Scheinin M. Dexmedetomidine attenuates sympathoadrenal responses to tracheal intubation and reduces the need for thiopentone and peroperative fentanyl. Br J Anaesth 1992;68(2):126–31.
11. Liang X, Zhou M, Feng JJ, Wu L, Fang SP, Ge XY, et al. Efficacy of dexmedetomidine on postoperative nausea and vomiting: meta analysis of randomized controlled trials. Int J Clin Exp Med 2015;8(6):8450–7.
12. Jin S, Liang DD, Chen C, Zhang M, Wang J. Dexmedetomidine prevents postoperative nausea and vomiting in patients during general anesthesia: PRISMA compliant meta analysis of randomized controlled trials. Medicine (Baltimore) 2017;96(1):e5770.
13. Kim SH, Oh YJ, Park BW, Sim J, Choi YS. Effects of single dose dexmedetomidine on quality of recovery after modified radical mastectomy: randomized controlled trial. Minerva Anestesiol 2013;79(11):1248–58.
14. Massad IM, Mohsen WA, Basha AS, Al Zaben KR, Al Mustafa MM, Alghanem SM. Balanced anesthesia with dexmedetomidine decreases postoperative nausea and vomiting after laparoscopic surgery. Saudi Med J 2009;30(12):1537–41.
15. Abdelmageed WM, Elquesny KM, Shabana RI, Abushama HM, Nassar AM. Analgesic properties of dexmedetomidine infusion after uvulopalatopharyngoplasty in patients with obstructive sleep apnea. Saudi J Anaesth 2011;5(2):150–6.
16. Goksu S, Arik H, Demiryurek S, Mumbuc S, Oner U, Demiryurek AT. Effects of dexmedetomidine infusion in patients undergoing functional endoscopic sinus surgery under local anaesthesia. Eur J Anaesthesiol 2008;25(1):22–8.
17. Blaudszun G, Lysakowski C, Elia N, Tramèr MR. Effect of perioperative systemic α2 agonists on postoperative morphine consumption and pain intensity: systematic review and meta analysis of randomized controlled trials. Anesthesiology 2012;116(6):1312–22.
18. Jain G, Bansal P, Ahmad B, Singh DK, Yadav G. Effect of perioperative infusion of dexmedetomidine on chronic pain after breast surgery. Indian J Palliat Care 2012;18(1):45–51.
19. Singh M, Tiwari AB, Taank P, Singh S, Kaur A, Sood M, et al. Comparative study on effects of dexmedetomidine and dexamethasone on incidence of postoperative nausea and vomiting in patients undergoing laparoscopic surgery. J Acute Dis 2022;11(2):59–64.
20. Seyam SH. Comparative study between dexamethasone and dexmedetomidine as adjuvant to ondansetron for prevention of postoperative nausea and vomiting following functional endoscopic sinus surgery. Ain Shams J Anaesthesiol 2017;10(2):156–63.
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