To Compare the Effect of Two Different Doses of Dexmedetomidine on the Attenuation of Airway and Pressor Response during Tracheostomy Tube Change in Traumatic Brain Injury Patients

BACKGROUND: Tracheostomy tube (TT) change is the common procedure in trauma Intensive Care Unit (ICU) and almost always associated with cough reflex, increase in blood pressure, and heart rate. Dexmedetomidine (DEX) is a selective α(2)-adrenergic receptor agonist well studied for the prevention of pressor response during laryngoscopy and extubation, but literature on prevention of pressor response during TT change is lacking. AIMS: The aim of this study is to compare two doses (0.5 and 1.0 μg/kg) of DEX for prevention of cough and pressor response during TT change in traumatic brain injury patients. SETTINGS AND DESIGN: Prospective randomized, double-blind trial. MATERIALS AND METHODS: Sixty tracheostomized traumatic brain injury patients in ICU scheduled for TT change were randomized to two equal groups: Group A to receive DEX 0.5 μg/kg and Group B to receive DEX 1.0 μg/kg. Calculated dose of studied drug was given by infusion pump over 10 min after dilution in 50 ml. Hemodynamic parameters, cough reflex, and adverse event were recorded and statistically analyzed. STATISTICAL ANALYSIS: Statistical analysis was done with nonpaired (two tailed, independent) Student's t-test for continuous data. Demographic data were compared using Pearson's χ(2) test. P < 0.05 was considered to be statistically significant. RESULTS: Both doses of DEX were able to attenuate the hemodynamic response of tracheal stimulation and cough reflex. Cough reflex was better controlled with 1.0 μg/kg dose but associated with increased incidence of hypotension and bradycardia. CONCLUSIONS: We conclude that 0.5 μg/kg dose provides desired attenuation of hemodynamic response during TT change without any significant adverse events.