Reduction of Airway-Related Complications by Dexmedetomidine in Nasal Surgeries

Abstract
Background: Nasal surgeries can stimulate various sites from the nasal mucosa to the diaphragm and the presence of endotracheal tube can induce some complications like cough-ing, laryngospasm and laryngeal oedema . To reduce airway reflexes, tracheal extubation should be performed by special technique or use of some drugs as dexmedetomidine which has sedative and analgesic effects, without affecting respiratory status.
Aim of Study: The primary outcome of this study is to evaluate the effect of dexmedetomidine adminstration on airway reflexes during extubation in nasal surgeries, the secondry outcome of this study is evaluation of hemodynamic response to the added medication (dexmedetomidine) and way of extubation.
Patients and Methods:
Type of study: Prospective randomized single-blinded, clinical comparative study.
Number of Patients: 60 patients of both sexes, (ASA) class I and II, admitted for elective nasal surgeries, randomly allocated into two groups each of 30 patients, Group N: “No Stimulation” technique, This technique avoids extubation under light anesthesia and ensures extubation only when consciousness is returned. It requires absolutely no stimulation during emergence and performing extubation only when the patient wakes up spontaneously and opens his eyes. Group D: Dexmedetomidine-group, who received intravenous (I.V) dexmedetomidine 0.5-1mg/kg bolus in 100ml of normal saline over 10 minutes at the end of surgery, followed by 0.2pg/kg/hr which was stopped immediately when extubation was done.
Results: The following parameters were assessed between the two groups: Airway reflexes, hemodynamics, extubation time, Regarding airway reflexes (coughing, bucking, laryn-gospasm and oozing from the wound) the results of our study showed that the incidence of coughing and bucking were significantly less in group D more than group N. As regard hemodynamic response the present results showed that the changes in MAP during emergence extubation were signifi-cantly less in dexmedetomidine group than “No Stimulation” technique group. As regard extubation time it was prolonged in group N more than groups D.
Conclusion: This study showed that the use of dexme-detomidine reduce the airway reflexes and hemodynamic response further to the advantage of short extubation time compared with the “No Stimulation” technique.