Title: Role of Dexmedetomidine on Hemodynamics and Anesthetic Requirement During Elective Intracranial Tumor Surgery - A Prospective Randomized Double Blind Placebo Controlled Study
Authors: Amrita Roy, Suman Sarkar, Sankari Santra, Anusua Banerjee, Shanta Ganguly
DOI: http://dx.doi.org/10.18535/jmscr/v3i8.54
DIDS : 08.2015-XXXXXXX
Abstract
Background: The objective of present study was to compare the effects of dexmedetomidine with placebo on intraoperative hemodynamics and anesthetic requirements during intracranial tumor surgery.
Methods: Ninety patients of ASA physical status 1 or 2, scheduled for elective intracranial tumor surgery, were allocated into group D and group C each consisting of 45 patients. Group D received dexmedetomidine 1 μg/kg over 10 minutes followed by maintenance infusion 0.4μg/kg/hr which was discontinued at skin closure. Group C received normal saline in a similar manner. Anesthesia was induced after 20 minutes of starting the maintenance infusion with propofol and maintained with nitrous oxide in oxygen, continuous infusion of propofol, atracurium and intermittent fentanyl. Heart rate, systolic, diastolic and mean blood pressures were recorded and compared. The requirements of propofol and fentanyl in both groups were also compared.
Results: Dexmedetomidine significantly attenuated hemodynamic response at intubation, head pin fixation, skin incision, making of burr hole, opening of dura and at extubation (p 0.00). Total dose of propofol as well as induction and maintenance dose requirement were significantly lower in group D (p < 0.0001). Total and hourly fentanyl requirement was also less in group D (< 0.0001). Patients in group D were extubated earlier than patients in group C (p < 0.0001). Group D patients required less postoperative analgesic (p 0.026).
Conclusion: Dexmedetomidine attenuated the hemodynamic response significantly, maintained perioperative hemodynamic stability, decreased extubation time as well as reduced intraoperative propofol and fentanyl and postoperative analgesic requirement in intracranial tumor surgery.
Key words: Dexmedetomidine, Propofol, Fentanyl, hemodynamics, Intracranial tumor surgery
References
1. Basali A, Mascha EJ, Kalfas I, Schubert A. Relation between perioperative hypertens-ion and intracranial hemorrhage after craniotomy. Anesthesiology 2000; 93:48-54.
2. Gunes Y, Gunduz M, Ozcengiz D, Ozbek H, Isik G.Dexmedetomidine-remifentanil or propofol-remifentanil anesthesia in patients undergoing intracranial surgery. Neurosurg Q 2005; 15: 122-6.
3. Tanskanen P, Kytta J, Randell T, Aantaa R. Dexmedetomidine as an anaesthetic adjuvant in patients undergoing intracranial tumor surgery: a double-blind, randomized and placebo-controlled study. Br J Anaesth 2006;97: 658–65.
4. Hall JE, Uhrich TD, Barney JA, Shahbaz RA, Ebert TJ. Sedative, amnestic, and analgesic properties of small dose dexmedetomidine infusions. Anesth Analg 2000; 90: 699-705.
5. Bekker A, Sturaitis M. Dexmedetomidine for neurological surgery. Neurosurgery 2005; 57: 1-10.
6. Scheinin B, Lindgren L, Randell T, Scheinin H, Scheinin M. Dexmedeto-midine attenuates sympathoad-renal response to tracheal intubation and reduces the need for thiopentone and peroperative fentanyl. Br J Anaesth 1992; 68: 126-31.
7. Belleville JP, Ward DS, Bloor BC, Maze M. Effects of intravenous dexmedeto-midine in humans. I. Sedation, ventilation, and metabolic rate. Anesthesiology 1992; 77: 1125-33.
8. Aho M, Erkola O, Kallio A, Scheinin H, Korttila K. Dexmedetomidine infusion for maintenance of anesthesia in patients undergoing abdominal hysterectomy. Anesth Analg 1992; 75: 940-6.
9. Aantaa R, Jaakola ML, Kallio A, Kanto J. Reduction of the minimum alveolar concentration of isoflurane by dexmedetomidine. Anesthesiology 1997; 86: 1055-60.
10. Kallio A, Scheinin M, Koulu M, et al. Effects of dexmedetomidine, a selective alpha 2- adrenoceptor agonist, on hemodynamic control mechanisms. Clin Pharmacol Ther 1989; 46: 33-42.
11. Olsen K, Pedersen C, Madsen J, Ravn L, Schifter S. Vasoactive modulators during and after craniotomy: relation to postoperative hypertension. J Neurosurg Anesth 2002; 14: 171-9.
12. Kross R, Ferri E, Leung D, Pratila M, Broad C, Veronesi M, Melendez J. A comparative study between a calcium channel blocker (nicardipine) and combined α-β-blocker (labetelol) for the control of emergence hypertension during craniotomy for tumor surgery. Anesth Analg 2000; 91: 904-9.
13. Haas C, LeBlac J. Acute postoperative hypertension: a review of therapeutic options. Am J Health- Syst Pharm 2004; 61: 1661-73.
14. Akopov S, Simonian N, Kazarian A. Effects of nifedipine and Nicardipine on regional cerebral blood flow distribution in patients with arterial hypertension. Methods Find Exp Clin Pharmac 1996; 18: 685-92.
15. Chadha R, Padmanabhan V, Joseph A, Mohandas K. Oral clonidine pretreatment for hemodynamic stability during craniotomy. Anaesth Intensive Care 1992; 20: 341-4.
16. Bekker A, Basile J, Gold M, Riles T, Adelman M, Cuff G, Mathew J, Goldberg J. Dexmedetomidine for awake carotid carotid Endarterectomy: efficacy, hemodynamic profile, and side effects. J Neurosurg Anesth 2004; 16: 126-35.
17. Marshall CA, Jones RM, Bajorek PK, Cashman JN. Recovery characteristics using isoflurane or propofol for maintenance of anaesthesia: a double-blind controlled trial. Anaesthesia 1992; 47; 461-6.
18. Burow, BK. Johnson ME. Packer DL. Metabolic Acidosis Associated with Propofol in the Absence of Other Causative Factors. Case report. Anesthesiology 2004; 101:239–41.
19. Salengros JC, Velghe-Lenelle CE, Bollens R, Engelman E, Barvais L. Lactic Acidosis during Propofol–Remifentanil Anaesthesia in an Adult. Case report. Anesthesiology 2004; 101:241–3.
20. Hatch DJ. Propofol infusion syndrome in children. Lancet 1999; 353: 1117–18.