COMPARISON OF NTG VS DEXMEDETOMIDINE FOR CONTROL OF HAEMODYNAMIC RESPONSE IN PATIENTS DURING EMERGENCE FROM ANAESTHESIA AND EXTUBATION FOLLOWING LAPAROSCOPY

Abstract

Endotracheal intubation as well as extubation are associated with various cardiovascular and airway responses leading to increase in heart rate (tachycardia), hypertension (HTN), cardiac arrhythmias, myocardial ischemia (MI), coughing, agitation, bronchospasm, increased bleeding, raised intracranial tension etc. Pneumoperitoneum creation in laparoscopic surgeries, leads to adverse changes in various systems of human body including cardiovascular, respiratory and acid base balance system. Various factors which leads to haemodynamic changes in patient are release of catecholamine, carbon di-oxide absorption, vasopressin release and position of the patient. NTG generate NO (Nitric oxide) which causes vasodilatation in vascular smooth muscle leading to decrease in blood pressure. It also relaxes the respiratory tract smooth muscle and hence it is preferred by anaesthesiologist to prevent laryngospasm. Dexmedetomidine is an 2-adrenoreceptor agonist used to facilitate the extubation after surgeries. Dexmedetomidine used in the intraoperative period causes decrease in serum catecholamine levels by 90%, which in turn blunts the haemodynamic response to laryngoscopy, tracheal intubation, pneumo-peritoneum and extubation. So we did the comparative study between IV dexmedetomidine and IV NTG on hemodynamic response during extubation in laparoscopic surgeries. To study and compare the effect of intravenous nitro-glycerine (NTG) with dexmedetomidine in patients undergoing laparoscopic surgery and during recovery in terms of haemodynamic response during tracheal extubation, airway reexes during tracheal extubation by using extubation quality score, sedation by using Ramsay Sedation Scale & side effects of drug. 60 patients of ASA grade 1 and 2 undergoing laparoscopic surgery were divided into two groups of thirty each. GROUP D (n=30) will receive Dexmedetomidine infusion at the rate of 0.75 mics/kg over 10 minutes and GROUP N (n=30) will receive NTG infusion at the rate of 2 mics/kg over 10 minutes .patients were assessed on the basis of ramsay sedation scale , extubation quality scale and vas scale every 1, 3, 5, 10 and 15 minutes. When both the groups were compared it was found out there was statistically signicant difference in dexmedetomidine group as compared to NTG in terms of decrease in HR , BP, SBP , DBP, MAP , extubation quality score , ramsay sedation scale, and VAS scale .there was no overall complication in both groups. In conclusion, the Dexmedetomidine at a dose of 0.75µg/kg body weight as compared to NTG ( 2 µg/kg body weight )when administered as infusion over 10 minutes, before tracheal extubation attenuates the airway reexes and hemodynamic responses effectively during emergence from anaesthesia providing smooth extubation. It provide adequate sedation, maintaining patient's arousability and delay the need for analgesia in the post-operative period.