Dexmedetomidine vs Labetalol for Airway Stress in Hypertensive Craniotomy Patients

Extubation quality will be assessed immediately after extubation using a standardized 5-point scale, where:

• = No cough, smooth extubation
• = Minimal coughing (1-2 times), smooth extubation
• = Moderate coughing (3-4 times)
• = Severe coughing (5-10 times) or difficulty breathing
• = Poor extubation, very uncomfortable, forced breathing (e.g., laryngospasm or coughing >10 times)

A lower score indicates better extubation quality. The outcome will be evaluated by a blinded observer within the first 5 minutes post-extubation.

Sedation level will be evaluated using the Richmond Agitation-Sedation Scale (RASS) within 10 minutes following extubation. The RASS is a validated tool for assessing the level of consciousness in patients, with scores ranging from +4 (combative) to -5 (unarousable). A score of 0 indicates an alert and calm state, while negative scores represent increasing levels of sedation and positive scores reflect agitation.

Mean Arterial Pressure (MAP) will be recorded at baseline (pre-drug administration), during drug infusion, immediately post-extubation, and at 1, 3, and 5 minutes after extubation. The goal is to evaluate the extent to which MAP deviates from baseline values following administration of either dexmedetomidine or labetalol. MAP stability is defined as values maintained within ±20% of baseline. This outcome will be used to assess the effectiveness of each drug in attenuating hemodynamic responses associated with extubation in hypertensive patients undergoing craniotomy.

Heart rate (HR) will be recorded at baseline (prior to administration of the study drug), during drug infusion, immediately after extubation, and at 1, 3, and 5 minutes post-extubation. The primary objective is to compare heart rate responses between the dexmedetomidine and labetalol groups and determine how effectively each drug maintains HR within ±20% of the baseline. This outcome will help evaluate the efficacy of both interventions in attenuating the sympathetic response to extubation in hypertensive patients undergoing craniotomy.

Adverse events will be monitored and documented from the start of study drug administration until 10 minutes post-extubation. Events of interest include bradycardia (heart rate < 50 bpm), hypotension (MAP decrease > 20% from baseline), respiratory depression, laryngospasm, severe coughing, nausea, vomiting, or any other clinically significant complication. All adverse events will be recorded, classified by severity, and managed according to standard anesthetic protocols. This outcome aims to compare the safety profiles of dexmedetomidine and labetalol in the context of emergence from anesthesia in hypertensive patients undergoing craniotomy.