Comparison of the efficacy of dexmedetomidine and esmolol in the treatment of increased hemodynamic response during the recovery period

Abstract

Introduction: Hemodynamic response during endotracheal extubation is a serious complication. It can be harmful especially in patients who have certain type of surgeries (intracranial, intraocular). All efforts should be shown in order to attenuate hemodynamic response during extubation. Objective: The aimof our studywas to compare effectiveness of esmolol and dexmedetomidine in the treatment of increased hemodynamic response during anesthesia recovery period. Methods: Sixty ASA I‐II patients whom scheduled for elective surgery with endotracheal intubation were randomized at the end of surgery according to their hemodynamic parameters that were increased 20% of their baseline values in order to receive 1 mg/kg esmolol (group E, n1/430) or 0.5 mg/kg dexmedetomidine (group D, n1/430). Before induction (C), before study drug (T1) and at 1st, 3rd, 5th and 10th min after the study drug administration (T2, T3, T4, T5), before extubation (T6), and just after extubation (T7), at 1st, 3rd, 5th, 10th, and 15th min after extubation (T8,T9,T10,T11,T12) heart rate(HR), systolic blood pressure( SBP), diastolic blood pressure(DBP), mean blood pressure( MBP), peripheral oxygen saturation (SpO2), end tidal carbon dioxide (ETCO2) values were recorded. Extubation time and recovery time were recorded. The time until the need of analgesic (VAS.4) was recorded. Cognitive functions were evaluated by 'short orientation memory concentration test (SMOCT)' at 20th and 50th min. Results: After giving the study drugs, HR reductions at all periods were significant in group D (T2‐T10: p<0.001, T11:p1/40.001, T12:p1/40.006). In group D SBP was high at 3rd min after drug (p<0.001), and SBP were lower in all periods before and after extubation (T6‐T10: p<0.001, T11:p1/40.02, T12:p1/40.04). In group D, DBP was higher at 1st min after drug (p1/40.001), DBP were lower at 10th min after drug and before extubation (p1/40.045, p1/40.001). In group D MBP 3rd min after drug was higher (p1/40.019) and MBP were lower at all other periods (T4‐T10:p<0.001, T11:p1/40.001, T12:p1/40.03). SpO2 in group D was higher at all periods after drug (p1/40.001, p1/40.003, p1/40.002, p1/40.007, p1/40,001, p1/40.001, p1/40.002, p1/40.001). In group D ETCO2 values at 5th and 10th min after drug were higher (p1/40.44, p1/40.49). The time until the need of analgesic and recovery period were longer in dexmedetomidine group (p<0.001). Discussion and Conclusion: Although both esmolol and dexmedetomidine attenuated the hemodynamic response during recovery period, dexmedetomidine was more effective in hemodynamic stabilization and time until the need of analgesic was longer. Dexmedetomidine was an agent that could be chosen for the attenuation of hemodynamic response during the extubation period. Esmolol provided faster recovery time. We believe that in order to get more effective attenuation of hemodynamic response, dosage studies with esmolol are needed.