COMPARATIVE EVALUATION OF INTRAVENOUS DEXMEDETOMIDINE AND LIGNOCAINE FOR HEMODYNAMIC STABILITY DURING TRACHEAL EXTUBATION: A RANDOMIZED DOUBLE-BLIND CLINICAL STUDY

Abstract

Tracheal extubation, though routine, is often accompanied by undesirable hemodynamic responses such as tachycardia, hypertension, and arrhythmias. These responses arise primarily from airway irritation and sympathetic stimulation and can be particularly detrimental in patients with cardiovascular, cerebrovascular, or neurosurgical conditions. Pharmacological agents such as dexmedetomidine, a selective alpha-2 adrenergic agonist, and lignocaine, a local anesthetic with antiarrhythmic properties, are frequently used to attenuate these stress responses. However, their comparative effectiveness in managing extubation-induced hemodynamic changes remains an area of clinical interest.Aim:To compare the efficacy of intravenous dexmedetomidine versus lignocaine in attenuating hemodynamic responses during tracheal extubation in patients undergoing elective surgeries under general anesthesia.Methods:This prospective, randomized, double-blind study was conducted on 60 adult patients (aged 18–50 years) of ASA physical status I–II, scheduled for elective surgeries requiring endotracheal intubation under general anesthesia. Patients were randomly allocated into two groups:Group D received intravenous dexmedetomidine 0.5 μg/kg infused over 10 minutes before extubation.Group L received intravenous lignocaine 1.5 mg/kg over the same duration.Hemodynamic parameters, including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP), were recorded at the following time points: baseline, pre-drug administration, during extubation, and at 1, 3, 5, and 10 minutes post-extubation.Results:Baseline and pre-intervention hemodynamic values were comparable between the two groups (p > 0.05). However, during and after extubation, Group D (dexmedetomidine) exhibited significantly lower HR and MAP compared to Group L (lignocaine), with p-values < 0.05 at all post-extubation time points. Dexmedetomidine effectively blunted the sympathetic surge typically associated with extubation, whereas lignocaine showed moderate attenuation with a higher peak in HR and BP during early recovery.Conclusion:Intravenous dexmedetomidine is more effective than lignocaine in providing hemodynamic stability during tracheal extubation. Its central sympatholytic action results in smoother emergence from anesthesia, making it a preferred agent, especially in patients at risk of hemodynamic instability. Incorporating dexmedetomidine into extubation protocols may enhance patient safety and recovery quality in the perioperative setting.