The Effects Of Dexmedetomidine On Airway Reflexes And Hemodynamic Responses To Tracheal Extubation

Primary objectivesTo compare the effects of two doses of dexmedetomidine in PACU:1.Airway Reflexes during Tracheal Extubation.2.The Time to open eyes and time to tracheal extubation3.Hemodynamic Responses peri-Tracheal Extubation.Secondary objectives:1.The Ramsay score,Postoperative pain after 30 min extubation.2.The adverse effects of PONV,delirium and others3.Patient satisfaction and VAS pain score at postoperative-24hr on the ward.Design:A randomized controlled clinical trial.Setting:Third Affiliated Hospital of Chongqing Medical University,China,03-2018-09-2018Interventions:Patients were randomized into three groups:A,B and C.Each group had 24 patients(n=24).Group A,the control group,received sufentanil(0.1 fig/kg),group B received dexmedetomidine 0.25 ?g/kg+sufentanil 0.1 ?g/kg and group C dexmedetomidine 0.5 vg/kg+sufentanil 0.1 ?g/kg,each of the medication was diluted into 10 ml of 0.9/NS and was pumped at lml/min iv.commenced at a standard time point at the resection of the gall bladder.Measurements:In(PACU),vital signs including BP,HR were measured at intervals of 5min,time to open eyes and to tracheal extubation,incidence of cough,level of sedation(Ramsay score),VAS score,and postoperative satisfactory score and other side effects were evaluated.Main Results:The incidence of cough was significantly less in group B and group C compared to the control group A(p=0.046,p=0.003)respectively.The time to eyes opening and tracheal extubation was comparable between the group A(16.7314.300,16.7314.300)and B(18.21±5.429),no significant differences(p=0.398,p=0.334)respectively,but was significantly longer in group C(23.4517.551,23.5517.520)when compared with group A and B(p=0.004,p=0.004).There was a significant increase in HR and MAP at extubation time in group A compared with group C(p=0.009,p=0.027)respectively.The Ramsay sedation score was significantly higher in Group C compared to group A(p=0.005).Postoperative VAS pain score 30 min in PACU and 24 hour in the ward was significantly less in group C compared with group A(p=0.013,p=0.028)respectively.24 hours postoperatively,group B and C were found to be significantly more satisfied than the control group A(p=0.001,p=0.001 respectively).Conclusion:Group B and C(dexmedetomidine 0.25 mcg/kg,0.5 mcg/kg)respectively were able to significantly decrease the incidence of cough during tracheal extubation.Group C significantly prolonged the time to eyes opening,tracheal extubation and had a higher Ramsay sedation score.Group C also attenuated hemodynamic disturbances and Postoperative pain.Both group B and C increase patient' s postoperative satisfaction.