Dexmet Vs Lignocaine

Comparison of Efficacy between Dexmedetomidine and Lignocaine
for Attenuation of Extubation Responses

Dr.E ARAVINDARAGHAVAN, Final year postgraduate student
ISA No : A 4607/A
Dr.SHEETAL JAYAKAR, Associate Professor

Dr POONAM VIJAY BHARAMBE, Assistant Professor

DR.D.Y.PATIL MEDICAL COLLEGE HOSPITAL & RESEARCH CENTRE, PUNE
Comparison of Efficacy between Dexmedetomidine and Lignocaine for Attenuation of Extubation Responses
Background
• Tracheal extubation is associated with haemodynamic changes due to reflex

sympathetic discharge resulting in hypertension, tachycardia and
arrhythmias.
• Extensive research has been done to attenuate hemodynamic responses to

intubation, but a reliable technique for rapid and smooth extubation is still
not fully evolved
Aim of the Study
• To compare the effect of single-dose

dexmedetomidine and lignocaine on the
attenuation of circulatory and airway
response to endotracheal extubation
Methods and Materials • ASA grade I or II.
• Age between 18 to 65 years.
• Availability of a written and informed consent.
Inclusion • Patients undergoing surgery under general anesthesia
Criteria • Hemodynamically stable patients with all routine investigations
• Single Centre Prospective within normal limits.
Observational Comparative • Duration of surgery less than 3hrs
Study • Pregnant Women
• 60 patients • Patients with heart diseases like congestive heart failure,
• 18-65 year group posted for coronary heart disease, any degree of heart block and
surgery under GA cardiogenic shock
• Patients taking drugs like β‑ blockers,digoxin,α2‑ agonists, Anti-
convulsants or psychotropic medications
Exclusion • Patient with pre-operative heart rate < 45beats/minute
Criteria • Patient with renal insufficiency and liver impairment
• Patient with coagulopathy and psychiatric disorders
• Patient with known allergy to studied drugs
• Patients who required postoperative mechanical Ventilation
• Patient with ASI >II
• Patient unwilling to get enrolled in the study
Methods and Materials:
1.The institute ethics committee approval
2.pre-anaesthetic evaluation and relevant laboratory investigations.
3.Informed written consent
4.60 patients randomly divided into two groups of 30 each of either sex in age
group of 18-65 years posted for surgery under General Anaesthesia (Computer
generated chart)
5.Dexmedetomidine group and Lignocaine groups were given their respective drug.
1.Group D: Dexmedetomidine group(n=30)will receive bolus dose of 0.5microgm/kg given 10
minutes before extubation.
2.Group L: Lignocaine group (n=30) will receive bolus dose 1.5mg/kg given 10 minutes before
extubation
Assessment of Hemodynamic parameters
• Parameters assessment
• Non-invasive blood pressure measurement
• Heart rate,
• Oxygen saturation.
• Timeline of assessment
• preoperatively (baseline),
• intra-operatively (for every 15 mins), until the completion of surgery.
• After extubation and full recovery, patients were transferred to the post
anesthesia care unit.
Hemodynamic parameters after
Bolus inj of DEXMEDETOMIDINE Vs LIGNOCAINE
Pulse SBP DBP MAP RR SPO2
Baseline vitals T0
10 min before intubation T1

10 min after intubation T2
Just before the Bolus injection/10 T3
min before extubation
At the time of Extubation T (E)
After extubation T4-15mins
T5 - 30mins
T6 - 45 mins
T7 - 60mins
T8 -1.15
T9 -1.30
T10 -1.45
T11- 2.00

Secondary Outcomes
• Airway response under direct laryngoscopy to suction were noted by

five-point scale
• The level of sedation during suction and extubation were be assessed
using Observer assessment sedation score
• Smoothness of extubation were noted by four-point scale
Airway response under direct laryngoscopy to suction
Grade:
Excellent
1 Breathing well, no response to laryngoscopy/suctioning
Good
2 Breathing well, minimal grimacing to laryngoscopy/suctioning
Satisfactory
3 Breathing well, cough attempt to laryngoscopy and suctioning
Poor
4 Breathing well, Coughing on tube during laryngoscopy
Very Poor
5 Coughing on tube with breath holding

Observer assessment sedation score
• Responds readily to name spoken in normal tone
1
• Lethargic response to name spoken in normal tone

2
• Responds only after name is called loudly/repeatedly

3
• Responds only after mild prodding or shaking

4
• Does not respond to mild prodding or shaking

5
Smoothness of extubation
1.
1. No coughing on endotracheal tube
2. Coughing on the tube
3. Vomiting
4. Laryngospasm
Statistical Analysis:
• All cases were completed within stipulated time.

• Data were compiled and tabulated.
• The statistical analysis were done using parametric test and the final
interpretation was based on ‘ANOVA‘ test’(standard normal variant)
with 95% level of significance.
Demographic Data and Baseline Characteristics:
VARIABLES GROUP D GROUP L

AGE (YEARS) 39 42
SEX (M/F) 15/15 16/14
ASA STATUS (I/II) 14/16 17/13
Mean Weight/Kg 66 63
Mean Basal Heart rate/Min 83 79
Mean Basal MAP mm/Hg 101 95
Mean Duration of Anaesthesia ( hours) 2.5 2.4
CHANGE IN HEART RATE PER MINUTE
90
80
70
60
HEART RATE
50
40
30
20
10
0 T2 (After Intubation) T3 (Bolus injection) TE (During Extubation) T4 T5

(15 MINS AFTER EXTUBATION) (30 MINS AFTER EXTUBATION)
CHANGE IN BLOOD PRESSURE (MAP)
104
102
100
BLOOD PRESSURE mm/Hg
98
96
94
92
90
T2 (After Intubation) T3 (Bolus injection) TE (During Extubation) T4 T5
(15 MINS AFTER EXTUBATION) (30 MINS AFTER EXTUBATION)
AIR WAY RESPONSE AT EXTUBATION
20
18
16
14
NUMBER OF PATIENT
12
10
0
GRADE 1 GRADE 2 GRADE 3 GRADE 4 GRADE 5
Summary of Results
• The demographic profile and baseline characteristics such as HR and MAP,
duration of surgery and duration of anaesthesia between the two groups were
comparable
• Use of dexmedetomidine was associated with less increase in HR as compared to
lignocaine group. Bradycardia occurred in one patient within 1 minute of drug
administration in group D
• MAP was better controlled in the dexmedetomidine group than in lignocaine
group
• Dexmedetomidine group showed better airway response during laryngoscopy
and oral suctioning when compared to Lignocaine group
• The smoothness of extubation was comparable between the two groups
• Both groups had a similar duration of recovery from anesthesia without delay in
emergence
Dexmedetomidine
• is a potent, alpha-2-selective adrenoceptor agonist
• Actions
• Sympatholytic effect
• Sedative
• Analgesic
• Other features
• Lack of respiratory depression
• Suppression of cough during extubation
Discussion
• Recovering from anesthesia often results in elevated catecholamine
concentration following anesthetic withdrawal which is further aggravated by
laryngeal manipulation occurring during extubation
• Studies have been carried out with use of diltiazem, lignocaine, esmolol,
labetalol, nicardipine and opioids as sole agent or in comparison with each other
• Dexmedetomidine, a potent alpha-adrenoceptor agonist, decrease the
sympathetic outflow and noradrenergic activity thereby counteracting the
hemodynamic fluctuation occurring at the time of extubation
• Central stimulation of parasympathetic outflow and inhibition of sympathetic
outflow from the locus ceruleous in the brainstem plays a prominent role in the
sedation and anxiolysis produced by dexmedetomidine
Conclusion
• Attenuation of pressor response is comparable between

dexmedetomidine and lignocaine
• Airway response was better controlled with use of dexmedetomidine
allowing a smooth easy tracheal extubation, thereby providing
comfortable recovery
• Dexmedetomidine group was associated with better sedation score
References
1. Guler G, Akin A, Tosun Z, Eskitascoglu E, Mizra A, Boyaci A. Single‑dose
dexmedetomidine attenuates airway and circulatory reflexes during extubation. Acta
Anaesthesiol Scand 2005;49:1088‑91. 17.
2. Lawrence CJ, De Lange S. Effects of a single pre‑operative dexmedetomidine dose
on isoflurane requirements and peri‑operative haemodynamic stability. Anaesthesia
1997;52:736‑44. 18.
3. Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco MD. The effects of increasing plasma
concentrations of dexmedetomidine in humans. Anesthesiology 2000;93:382‑94. 19.
4. Turan G, Ozgultekin A, Turan C, Dincer E, Yuksel G. Advantageous effects of
Dexmedetomidine on haemodynamic and recovery responses during extubation for
intracranial surgery. Eur J Anaesthesiol2008;25:816‑20. 16.
Thank You

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Comparison of Efficacy between Dexmedetomidine and Lignocaine

for Attenuation of Extubation Responses

Dr.SHEETAL JAYAKAR, Associate Professor

• Tracheal extubation is associated with haemodynamic changes due to reflex

• Extensive research has been done to attenuate hemodynamic responses to

• To compare the effect of single-dose

10 min before intubation T1

• Airway response under direct laryngoscopy to suction were noted by

1 Breathing well, no response to laryngoscopy/suctioning

2 Breathing well, minimal grimacing to laryngoscopy/suctioning

3 Breathing well, cough attempt to laryngoscopy and suctioning

4 Breathing well, Coughing on tube during laryngoscopy

5 Coughing on tube with breath holding

• Lethargic response to name spoken in normal tone

• Responds only after name is called loudly/repeatedly

• Responds only after mild prodding or shaking

• Does not respond to mild prodding or shaking

2. Coughing on the tube

• All cases were completed within stipulated time.

VARIABLES GROUP D GROUP L

Mean Duration of Anaesthesia ( hours) 2.5 2.4

0 T2 (After Intubation) T3 (Bolus injection) TE (During Extubation) T4 T5

• Attenuation of pressor response is comparable between

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