Comparison of Intratracheal Dexmedetomidine versus Lignocaine on Attenuating Emergence Cough Response to Extubation in Patients Undergoing Craniotomy for Intracranial Tumor: A Multi-arm Randomized Controlled Trial.
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OBJECTIVE: Smooth extubation is crucial for patients undergoing craniotomy. Multiple drug regimens, administered in different doses and via different routes, have been studied to attenuate the emergence of cough response. However, a direct comparison of their relative efficacy remains lacking. This study aims to compare the effect of intratracheal (IT) dexmedetomidine (DX) and IT lignocaine (LG) on the emergence of coughing and hemodynamic response to extubation in patients undergoing craniotomy. METHODS: This randomized, double-blind, multiarm controlled trial involved patients aged 18-60 years of either sex with an American Society of Anesthesiologists Physical status I or II, who were planned for elective craniotomy due to an intracranial tumor. Participants were randomly divided into three groups, each containing 15 individuals. Group DX received DX, Group LG received LG, and Group normal saline (NS) received NS intratracheally 15 min before extubation. The emergence of cough response was recorded during extubation, and hemodynamic parameters, including heart rate, mean blood pressure, and visual analog scale score, were monitored at different intervals throughout the study. STATISTICAL ANALYSIS AND RESULTS: A statistically significant difference was noted in the emergence of cough response between the DX and NS groups ( P < 0.05) as well as between the LG and NS groups ( P < 0.05), as determined by pairwise intergroup analysis using the Kruskal - Wallis test followed by Bonferroni post hoc correction. No significant difference in emergence cough scores was found between the DX and LG groups ( P = 0.66). CONCLUSIONS: Both IT DX and IT LG are equally effective in reducing the emergence cough response. However, IT DX offers the additional advantage of reducing the hemodynamic response to extubation and providing postoperative pain relief.