title: Effects of avoiding neuromuscular blocking agents during maintenance of anaesthesia on recovery characteristics in patients undergoing craniotomy for supratentorial lesions: A randomised controlled study.
abstract: OBJECTIVE
  Neuromuscular blocking agents have been one of the cornerstones of anaesthesia. With the advent of newer surgical, anaesthetic and neurological monitoring techniques, their utility in neuroanaesthesia practice seems dispensable. The aim of this prospective, comparative, randomised study was to determine whether neuromuscular blocking agents are required in patients undergoing supratentorial surgery when balanced anaesthesia with desflurane, dexmedetomidine and scalp block is used.
  
  
  METHODS
  Sixty patients with the American Society of Anesthesiologists physical status I or II, aged between 18 and 60 years were included in the study. All patients received anaesthesia including desflurane, dexmedetomidine and scalp block. The patients were randomly allocated to receive no neuromuscular blocking agent (Group A) or atracurium infusion to keep train-of-four count 2 (Group B). The two groups were compared with respect to haemodynamic stability, brain relaxation scores and recovery characteristics. Haemodynamic parameters and time taken to achieve Aldrete score >9 and other secondary outcomes were analysed using Student'st-test. Non-parametric data were analysed using the Mann-Whitney test.
  
  
  RESULTS
  The mean arterial pressure was comparable between the groups. The intraoperative heart rate was comparable; however, in the post-operative period, it remained higher in Group B for 30 min after extubation (P= 0.02). The brain relaxation scores were comparable among the two groups (P= 0.27). Tracheal extubation time, time taken for orientation and time required to reach Aldrete score ≥9 were comparable among the two groups.
  
  
  CONCLUSIONS
  The present study suggests that balanced anaesthesia using desflurane, dexmedetomidine and scalp block can preclude the use of neuromuscular blocking agents in patients undergoing supratentorial surgery under intense haemodynamic monitoring.
authors.affiliation: Department of Anaesthesia, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India.
authors.forename: Ruchi A
authors.initials: RA
authors.lastname: Jain
authors.affiliation: Department of Anaesthesia, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.
authors.forename: Anita N
authors.initials: AN
authors.lastname: Shetty
authors.affiliation: Department of Anaesthesia, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.
authors.forename: Shrikanta P
authors.initials: SP
authors.lastname: Oak
authors.affiliation: Department of Anaesthesia, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.
authors.forename: Anjana S
authors.initials: AS
authors.lastname: Wajekar
authors.affiliation: Department of Anaesthesia, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.
authors.forename: Madhu B
authors.initials: MB
authors.lastname: Garasia
keywords: Atracurium; desflurane; dexmedetomidine; neuroanaesthesia; neurosurgery; scalp block