title: Comparison of Dexmedetomidine and Remifentanil on Airway Reflex and Hemodynamic Changes during Recovery after Craniotomy.
abstract: OBJECTIVE
  During emergence from anesthesia for a craniotomy, maintenance of hemodynamic stability and prompt evaluation of neurological status is mandatory. The aim of this prospective, randomized, double-blind study was to compare the effects of dexmedetomidine and remifentanil on airway reflex and hemodynamic change in patients undergoing craniotomy.
  
  
  METHODS
  Seventy-four patients undergoing clipping of unruptured cerebral aneurysm were recruited. In the dexmedetomidine group, patients were administered dexmedetomidine (0.5 μg/kg) for 5 minutes, while the patients of the remifentanil group were administered remifentanil with an effect site concentration of 1.5 ng/mL until endotracheal extubation. The incidence and severity of cough and hemodynamic variables were measured during the recovery period. Hemodynamic variables, respiration rate, and sedation scale were measured after extubation and in the post-anesthetic care unit (PACU).
  
  
  RESULTS
  The incidence of grade 2 and 3 cough at the point of extubation was 62.5% in the dexmedetomidine group and 53.1% in the remifentanil group (p=0.39). Mean arterial pressure (p=0.01) at admission to the PACU and heart rate (p=0.04 and 0.01, respectively) at admission and at 10 minutes in the PACU were significantly lower in the dexmedetomidine group. Respiration rate was significantly lower in the remifentanil group at 2 minutes (p<0.01) and 5 minutes (p<0.01) after extubation.
  
  
  CONCLUSIONS
  We concluded that a single bolus of dexmedetomidine (0.5 μg/kg) and remifentanil infusion have equal effectiveness in attenuating coughing and hemodynamic changes in patients undergoing cerebral aneurysm clipping; however, dexmedetomidine leads to better preservation of respiration.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Hyunzu
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.|Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Kyeong Tae
authors.initials: KT
authors.lastname: Min
authors.affiliation: Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.|Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jeong Rim
authors.initials: JR
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sang Hee
authors.initials: SH
authors.lastname: Ha
authors.affiliation: Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Woo Kyung
authors.initials: WK
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jae Hee
authors.initials: JH
authors.lastname: Seo
authors.affiliation: Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.|Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea. csho99@yuhs.ac.
authors.forename: Seung Ho
authors.initials: SH
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D060666:Airway Extubation; D000762:Anesthesia Recovery Period; D003371:Cough / Q000188:drug therapy; D003399:Craniotomy / Q000009:adverse effects; D020927:Dexmedetomidine / Q000494:pharmacology* / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000494:pharmacology* / Q000627:therapeutic use; D011446:Prospective Studies; D012018:Reflex / Q000187:drug effects*; D000077208:Remifentanil; D012137:Respiratory System / Q000098:blood supply / Q000187:drug effects* / Q000503:physiopathology; D055815:Young Adult
chemical_list: D010880:Piperidines; D020927:Dexmedetomidine; D000077208:Remifentanil
keywords: Anesthesia recovery period; craniotomy; dexmedetomidine; remifentanil