Study of hemodynamic and airway reflexes during emergence from general anaesthesia and tracheal extubation with and without using dexmedetomidine in patients undergoing laparoscopic cholecystectomy

Abstract

Introduction: The emergence phase and tracheal extubation are critical due to potential hemodynamic changes and airway reflexes. This study aimed to evaluate Dexmedetomidine's effectiveness in mitigating these responses during extubation.

Methods: Forty-eight ASA Physical Status I and II patients, aged 18-60, undergoing elective laparoscopic cholecystectomy were enrolled at Shree Birendra Hospital, Kathmandu, Nepal, with Institutional Review Committee approval. Group D (n=24) received 0.25 mcg/kg Dexmedetomidine in 100 ml saline, while Group N (n=24) received 100 ml saline over 10 minutes at the end of surgery. Heart rate and mean arterial pressure (MAP) were recorded at baseline, 3, 5, and 10 minutes post-administration, during extubation, and at 1, 3, 5, and 10 minutes post-extubation. Extubation smoothness was rated on a 5-point scale. Statistical analysis included Fisher's Exact test, chi-square test, Mann-Whitney test, independent t-test, and repeated measures ANOVA (RM ANOVA). A p-value of <0.05 was considered significant.

Results: Demographic profiles and ASA-PS statuses were similar between groups. Group D had a lower heart rate compared to Group N at 10 minutes post-administration and showed more stable heart rate changes around extubation. Significant differences in heart rate were observed at 10 minutes post-administration, during extubation, and at 1, 3, 5, and 10 minutes post-extubation. Group N had higher MAP levels during and after extubation. Extubation smoothness was better in Group D, with 54.17% achieving a score of 1 versus 4.17% in Group N.

Conclusion: Dexmedetomidine effectively reduces hemodynamic reflexes and facilitates smoother extubation.