ABSTRACT : Tracheal extubation is the discontinuation of an artificial airway when the indications for its placement like airway obstruction, protection of airway, suctioning, ventilator failure and hypoxemia no longer exist. The α2-adrenoreceptor agonist, dexmedetomidine, provides excellent sedation with minimal cardiovascular instability or respiratory depression and may be a useful adjunct to facilitate smooth tracheal extubation.

METHODS : Sixty American Society of Anesthesiologists grade I-II patients, aged 20-50 years of either sex, scheduled for elective general surgical, urological and gynecological surgeries were studied after randomization into two groups. Group A received an intravenous infusion of dexmedetomidine 0.75 mcg/kg and Group B received a placebo respectively, over 15 minutes before anticipated time of end of surgery, in a double blind manner. Anesthesia techniques were standardized. Heart rate, systolic, diastolic, mean arterial pressures were recorded while starting injection, at 1, 3, 5, 10, 15 minutes . During extubation at 1, 3, 5 minutes and thereafter every 5 minutes for 30 minutes. Quality of extubation was evaluated on a 5 point scale and postoperative sedation on a 6 point scale. Any event of laryngospasm, bronchospasm, desaturation, respiratory depression, vomiting, hypotension, undue sedation was noted

RESULTS : Heart rate, systolic, diastolic, mean arterial pressures were significantly higher in group B ( P < 0.05). Extubation quality score of majority of patients was 2 in group A and 3 in group B. Sedation score of most patients was 3 in group A and 2 in group B. Bradycardia and hypotension incidences were higher in group A. Two patients in group A, three patients in group B had vomiting. No patient had any other side effects.

CONCLUSIONS :Dexmedetomidine 0.75 mcg/kg administered 15 minutes before extubation, stabilizes hemodynamics and facilitates smooth extubation.