Attenuating stress response of extubation in craniotomy: Dexmedetomidine vs magnesium sulphate

Context: Similar to intubation, Extubation is also associated with stressful airway response. Through not of same degree, it needs to be attenuated especially in neurosurgical patients, due to undesired haemodynamic instability.Aims: To compare beneficial effects of dexmedetomidine and magnesium sulphate in terms of quality of extubation and hemodynamic changes during extubation in craniotomy patients.Methods and Material: Sixty patients of ASA grade I and II, 18 -60 years scheduled for craniotomy were randomly allocated in two groups with 30 each. Group D and M received an infusion of dexmedetomidine 0.5µg/kg and magnesium sulphate 30 mg/kg respectively over ten min at the time of skin closure. HR, SBP and DBP were recorded just before drug administration, 3 and 5 min after drug administration, during extubation and at 3, 5, 10 and 15 minutes after extubation. Extubation quality was rated on five point scale and postoperative sedation on Ramsay sedation scale. Results: Haemodynamic values i.e HR, SBP, DBP and MAP were found to be significantly more acceptable in Group D then in group M (p<0.05). Majority of the patients (76.7%) of group D had an extubation quality score of one, whereas it was three in most of patients of group M (50%) (p<0.01). Sixty percent of patients in group D had a sedation score of 2 (calm) and 70% of group M had a score of 1 (anxious & agitated) (p<0.01).Conclusions: Dexmedetomidine provides a better attenuation of circulatory and airway responses during extubation as compared to magnesium.