Remifentanil-propofol vs dexmedetomidine-propofol--anesthesia for supratentorial craniotomy.
The aim of the present study was to compare the perioperative hemodynamics, propofol consumption and recovery profiles of remifentanil and dexmedetomidine when used with air-oxygen and propofol, in order to evaluate a postoperative analgesia strategy and explore undesirable side-effects (nausea, vomiting, shivering). In a prospective randomized double-blind study 50 ASAI-III patients scheduled for supratentorial craniotomy, were allocated into two equal Groups. Group D patients (n = 25), received i.v. dexmedetomidine 1 microg kg(-1) as preinduction over a 15-min period and 0.2-1 microg kg(-1) hr(-1) by continuous i.v. infusion during the operation period. Group R patients (n = 25), received remifentanil 1 microg kg(-1) as induction i.v. over a 15-min period and 0.05-1 microg kg(-1) min(-1) as maintenance. The propofol infusion was started at a rate of 10 mg kg(-1) h(-1) and titrated to maintain BIS in the range 40-50. Propofol doses for induction and maintenance of anesthesia was lower with dexmedetomidine (respectively p < 0.05, p < 0.01). The time for BIS to reach 50 was significantly shorter in Group D (p < 0.01). Comparison of the parameters of recovery revealed; extubation time (p < 0.01); response to verbal commands (p < 0.05) and time for orientation (p < 0.05) were longer with Group D. With respect to Post Anesthesia Care Unit (PACU) discharge time, dexmedetomidine patients required longer time when compared to remifentanil patients to achieve their first normal neurological score (33 min vs 31 min). The earliest opioid administration was at 38 min. in the dexmedetomidine group and 33 min. in the remifentanil group. Propofol-remifentanil and propofol-dexmedetomidine are both suitable for elective supratentorial craniotomy and provide similar intraoperative hemodynamic responses and postoperative adverse events. Propofol-remifentanil allows earlier cognitive recovery; however, it leads to earlier demand for postoperative analgesics. Undesirable side-effects were similar in two Groups.
Turgut
Namigar
N
Department of Anaesthesiology and Reanimation, S.B. Okmeydani Teaching and Research Hospital, Istanbul, Turkey. drnamigar@yahoo.com.tr
Turkmen
Aygen
A
Ali
Achmet
A
Altan
Aysel
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000762:Anesthesia Recovery Period; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects; D003071:Cognition / Q000187:drug effects; D003399:Craniotomy / Q000379:methods*; D020927:Dexmedetomidine; D004311:Double-Blind Method; D004569:Electroencephalography / Q000187:drug effects; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008875:Middle Aged; D010880:Piperidines / Q000494:pharmacology*; D011183:Postoperative Complications / Q000517:prevention & control*; D015742:Propofol / Q000494:pharmacology*; D011446:Prospective Studies; D000077208:Remifentanil; D014147:Tramadol / Q000627:therapeutic use; D055815:Young Adult
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D010880:Piperidines; D014147:Tramadol; D020927:Dexmedetomidine; D000077208:Remifentanil; D015742:Propofol