Dexdemetomidine for Prevention of Cough Response and Agitation in Patients with Intubation after Flap Reconstructive Surgery for Oral Cancer

Abstract Background: To investigate whether intraoperative infusion of dexmedetomidine could safely prevent the incidence of cough response and agitation in patients with intubation after flap reconstructive surgery for oral cancer.Methods: Sixty-four patients undergoing flap reconstructive surgeries were randomly divided into dexmedetomidine (D) group and control (C) group. Within 15 min before anesthesia induction, dexmedetomidine was infused with a 0.5μg/kg loading dose followed by a maintenance dose of o.4μg/kg/h in group D, while the same volume saline was administered in group C. All patients kept the tracheal tube and maintained spontaneous respiratory in intensive care unit (ICU). Postoperative cough response, the Richmond Agitation-Sedation Scale (RASS) score, the behavioral pain scale (BPS) score, blood oxygen saturation (SpO2 ), respiratory rate (RR) and end-tidal carbon dioxide (EtCO2) were recorded at 10min (T1), 20 min(T2), 30 min (T3), 1h(T4), 6h(T5), 12h(T6) and 24h (T7) after surgery. Meanwhile, the length of ICU stay and adverse effects were also calculated.Results: The data of 32 patients in each group were included in this study. The incidence of cough response were significantly lower in group D than that in group C at T1-6 (P<0.05); The RASS scores in group D were significantly lower than that in group C at T1-5 (P<0.05); The BPS score in group C was much higher than that in group D at all time-points (P<0.05). And there was no significant difference in the SpO2, RR, EtCO2, the length of ICU stay and other complications. Conclusion: Dexmedetomidine as an anesthetic adjuvant could safely prevent the incidence of cough response and agitation in patients with intubation after flap reconstructive surgery for oral cancer. Trial registration: Chinese Clinical Trial Registry, ChiCTR-1800018367.