Cigarette Smoking and the Effect of Dexmedetomidine and Fentanyl on Tracheal Intubation

Attenuation of the Airway and Cardiovascular Responses to Extubation in Chronic Smokers by Prior Treatment with Dexmedetomidine, Fentanyl, and their Combination

BACKGROUND: Respiratory complications and hemodynamic changes during and after extubation are more common than during tracheal intubation and induction of anesthesia. AIM: The objective of this study was to compare the efficacy of prior treatment with dexmedetomidine, fentanyl, and their combination on the attenuation of the airway and cardiovascular responses to extubation. METHODS: The subjects were adult chronic male smokers, representing the population in which secondary response to extubation is most common. A randomized double-blinded comparative trial was conducted on 66 patients who were 20–60 years of age, chronic male smokers, scheduled for elective surgeries, and divided into three equal groups according to given drug 20 min before the end of surgery. Group A (n = 22) received 1 ug. kg−1 dexmedetomidine, Group B (n = 22) received fentanyl 1 ug. kg−1, and Group C (n = 22) received a mixture of the previously used drugs in the same doses. Time to and quality of extubation, airway and hemodynamic responses, and post-operative agitation and sedation were recorded. RESULTS: Hemodynamic responses and quality of extubation were better in both Groups A and C than patients in Group B at the expense of increasing time to extubation, post-extubation sedation, and delayed recovery in Group C. CONCLUSION: Single-dose dexmedetomidine 1 ug. kg-1 given 15 min before extubation in chronic cigarette smokers provided better attenuation of the airway and cardiovascular responses to extubation and suctioning with better recovery profile when compared to fentanyl 1 ug. kg-1 and dexmedetomidine mixed with fentanyl in the same previous doses.