Efficacy of Dexmedetomidine for endotracheal tube tolerance, analgesia and sedation – A prospective randomised double blind controlled trial

Background: Endotracheal tube tolerance is a major concern in patients who require postoperative retention of endotracheal tube following major head and neck cancer surgeries. This study investigates the role of Dexmedetomidine for endotracheal tube tolerance, opioid sparing effect and sedation. Methods: Prospective randomised double blind control study. Sixty-four patients scheduled for head and neck surgery lasting longer than 2 h who require post operative endotracheal tube retention were randomly allocated into two groups of 32 each. The Dexmedetomidine group (Group D, n = 32) received Dexmedetomidine 1 μg kg−1 diluted to 10 ml, i.v. over 10 min prior to reversal and thereafter 0.2 μg kg−1 h−1 i.v. infusion till extubation while the control group (Group P, n = 32) received 10 ml normal saline i.v. over 10 min prior to reversal and volume-matched normal saline infusion as placebo till extubation. The two groups of patients were compared for haemodynamic changes during administration of the bolus drug, after reversal and in the ICU. The quality of endotracheal tube tolerance, analgesic requirement and sedation were also compared between the two groups in the ICU. Results: Group D tolerated the endotracheal tube better than Group P based on cough (p < 0.01) and nurses’ judgement (p < 0.01). Group D showed 72% decrease in morphine requirement (p < 0.05), experienced arousable sedation (p < 0.05) and the vital parameters were better preserved (p < 0.05) than Group P. Conclusions: Patients receiving Dexmedetomidine tolerated the endotracheal tube better, required lesser morphine, were adequately sedated, arousable, stable haemodynamics and lacked respiratory depression