Effect of dexmedetomidine versus fentanyl on recovery responses to tracheal extubation in vitrectomy, randomized, controlled trial

Abstract

Background: Our study was to compare the effects of fentanyl 1 mcg/kg IV and dexmedetomidine 0.5 mcg/kg IV as single bolus doses on the IOP, quality of extubation, hemodynamic responses during extubation, postoperative sedation, postoperative pain, and complications. Methods: Sixty patients were recruited randomly into three groups. 5 min before extubation, Group (I): received IV 10 ml of normal saline. Group (II): received fentanyl 1 mcg/kg IV in 10 ml of normal saline. Group (III): received 0.5 mcg/kg dexmedetomidine IV in 10 ml of normal saline. Our primary outcome was the intraocular pressure; our secondary outcomes were hemodynamic, extubation quality, extubation and recovery duration, postoperative pain, postoperative sedation, and complications. Results: The dexmedetomidine group IOP upon extubation was shown to be more stable than the fentanyl group. The preoperative and at the end of the operation hemodynamics measured in the three groups did not show any appreciable changes. However, we found that patients receiving dexmedetomidine saw much smaller increases in HR, and MBP following medication administration compared to patients receiving fentanyl, and both groups also experienced significantly lower increases than the control group. Dexmedetomidine considerably improved extubation quality compared to fentanyl, and both groups were significantly better than the control group. The dexmedetomidine group had considerably shorter extubation times than the other two groups. Conclusion: In contrary to fentanyl 1 mcg/kg IV, dexmedetomidine 0.5 mcg/kg given IV 5 minutes before extubation stabilizes IOP, and hemodynamic responses to extubation, and promotes smooth extubation without extending recovery time or increasing postoperative complications.