Dexmedetomidine as an anaesthetic adjuvant in patients undergoing intracranial tumour surgery: a double-blind, randomized and placebo-controlled study.
BACKGROUND
Dexmedetomidine (DEX) has been shown to provide good perioperative haemodynamic stability with decreased intraoperative opioid requirements. It may have neural protective effects, and thus may be a suitable anaesthetic adjuvant to neurosurgical anaesthesia.


METHODS
Fifty-four patients scheduled for elective surgery of supratentorial brain tumour were randomized to receive in a double-blind manner a continuous DEX infusion (plasma target concentration 0.2 or 0.4 ng ml(-1)) or placebo, beginning 20 min before anaesthesia and continuing until the start of skin closure. The DEX groups received fentanyl 2 microg kg(-1) at the induction of anaesthesia and before the start of operation, the placebo group 4 microg kg(-1), respectively. Anaesthesia was maintained with nitrous oxide in oxygen and isoflurane.


RESULTS
The median times from the termination of N2O to extubation were 6 (3-27), 3 (0-20) and 4 (0-13) min in placebo, DEX-0.2 and DEX-0.4 groups, respectively (P<0.05 anova all-over effect). The median percentage of time points when systolic blood pressure was within more or less than 20% of the intraoperative mean was 72, 77 and 85, respectively (P<0.01), DEX-0.4 group differed significantly from the other groups. DEX blunted the tachycardic response to intubation (P<0.01) and the hypertensive response to extubation (P<0.01). DEX-0.4 group differed in the heart rate variability from placebo (93 vs 82%, P<0.01).


CONCLUSIONS
DEX increased perioperative haemodynamic stability in patients undergoing brain tumour surgery. Compared with fentanyl, the trachea was extubated [corrected] faster without respiratory depression.
Tanskanen
P E
PE
Department of Anaesthesiology, Helsinki University Central Hospital Finland. paivi.tanskanen@hus.fi
Kyttä
J V
JV
Randell
T T
TT
Aantaa
R E
RE
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage* / Q000097:blood; D000328:Adult; D000368:Aged; D000769:Anesthesia, Inhalation; D001794:Blood Pressure / Q000187:drug effects; D001932:Brain Neoplasms / Q000601:surgery*; D002245:Carbon Dioxide / Q000097:blood; D003399:Craniotomy; D020927:Dexmedetomidine / Q000008:administration & dosage* / Q000097:blood; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D010313:Partial Pressure; D011182:Postoperative Care / Q000379:methods
D000759:Adjuvants, Anesthesia; D002245:Carbon Dioxide; D020927:Dexmedetomidine