Dexmedetomidine for tracheal extubation in deeply anesthetized adult patients after otologic surgery: a comparison with remifentanil

BACKGROUND Remifentanil and dexmedetomidine are well known to suppress airway reflexes during airway procedures. Smooth tracheal extubation is important after otologic surgery. The purpose of this study is to compare the effectiveness of dexmedetomidine or remifentanil infusion for producing smooth tracheal extubation in deeply anesthetized patients after otologic surgery. METHODS Seventy-four ASA I-II adult patients (18-60 years old) scheduled for elective otologic surgery were randomly assigned to one of three groups: sevoflurane-remifentanil (Group SR, n = 25), sevoflurane-dexmedetomidine (0.5 μg/kg) (Group SD5, n = 24), or sevoflurane-dexmedetomidine (0.7 μg/kg) (Group SD7, n = 25). Remifentanil or dexmedetomidine were administered for 10 min at the end of surgery. The primary outcome was the rate of smooth extubation. Respiratory pattern, airway obstruction, hemodynamic and respiratory profiles, time to awake, rescue analgesics in the post-anesthesia care unit (PACU), and postoperative nausea and vomiting (PONV) were also recorded. RESULTS The rate of smooth tracheal extubation as defined 1 min post-extubation was the same for Groups SR and SD7 (P > 0.05), but the rate of smooth extubation was lower for Group SD5 than for the other two groups (p < 0.05). During extubation, the respiratory rate was lower in Group SR than in both dexmedetomidine groups (p < 0.05). The hemodynamic profiles at extubation were similar between groups (p > 0.05), but the mean arterial pressure and heart rate were higher in Group SR at 10 and 15 min after extubation (p < 0.05). The incidence of airway obstruction and time to awake were comparable for all groups (p > 0.05). The need for rescue analgesic in the PACU was more common in Group SR than in both dexmedetomidine groups (P < 0.01). Compared to Group SR, both dexmedetomidine groups had less PONV on postoperative day 1 (p < 0.05). CONCLUSION Combined with 1 MAC sevoflurane, dexmedetomidine 0.7 ug/kg and remifentanil provided similar rates for smooth tracheal extubation in spontaneously breathing, anesthetized adults. Dexmedetomidine exhibited opioid-sparing effects postoperatively and was associated with less PONV than remifentanil.