A randomized Control Study of Dexmedetomidine Versus Fentanyl as An Anesthetic Adjuvant in Supratentorial Craniotomies. | [Anaesthesia, Pain and Intensive Care • 2017]

Author(s):

1. Amrita Gupta MD: Department of Anesthesiology, Sarojini Naidu Medical College (SNMC), Moti Katra, Agra, Uttar Pradesh, India

2. Yogita Dwivedi MD: Department of Anesthesiology, Sarojini Naidu Medical College (SNMC), Moti Katra, Agra, Uttar Pradesh, India

3. Sumi Saxena MD: Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Uttar Pradesh, India

4. Uma Srivastava MD DA: Department of Anesthesiology, Sarojini Naidu Medical College (SNMC), Moti Katra, Agra, Uttar Pradesh, India

5. Sandeep Mangla: Department of Anesthesiology, Sarojini Naidu Medical College (SNMC), Moti Katra, Agra, Uttar Pradesh, India

6. Sukhdev Mishra: Department of Health Research, Ministry of Health & Family Welfare, Government of India, Meghani Nagar, Ahmedabad, India

Abstract:

Introduction: Dexmedetomidine provides stable perioperative hemodynamic profile with decreased requirement of opioids. It has neuroprotective effect and may be suitable anesthetic adjuvant when compared to fentanyl. The main aim of our study was to compare dexmedetomidine and fentanyl in relation to blunting of sympathetic response to intubation and induction while secondary variables were to study their effect on perioperative hemodynamic changes, operative conditions, recovery profile and side effects.Methodology: In this double blind randomized control trial 50 patients of ASA I and II grade scheduled for elective neurosurgery were selected over a period of 1 year, after obtaining written informed consent. Patients were randomly divided into two groups; in Group-D patient received 1 µg/kg of dexmedetomidine as loading dose within 10 min before induction and 2 µg/kg of fentanyl at induction and 0.04-0.05 µg/kg/min of dexmedetomidine as maintenance during surgery. In Group-F patient received induction with 3 µg/kg of fentanyl and maintained with 0.02-0.03 µg/kg/min of fentanyl.Hemodynamic changes, cerebral relaxation store, recovery time and intraoperative and postoperative side effects were notedResults: Baseline heart rate and BP was similar in both the groups. In Group-D and F, Heart rate and BP were increased from baseline during intubation, skull clamping and extubation but were within physiological limits. The rise in heart rate and BP was comparatively lower in Group-D as compared to Group-F. all the values were statistically significant (p < 0.05)Cerebral relaxation score was lower in Group-D as compared to Group-F, along with faster recovery. During postoperative period there was no shivering nausea and vomiting in Group-D but in Group-F, 1 patient experienced shivering while 2 patients complained of nausea and vomiting.Conclusion: In our study we found that dexmedetomidine provided better hemodynamic profile as compared to fentanyl with better cerebral relaxation score and recovery time. Hence we conclude that dimetindene is safer and effective alternate to fentanyl as an anesthetic adjuvant in neurosurgery

Page(s): 306-311

DOI: DOI not available

Published: Journal: Anaesthesia, Pain and Intensive Care, Volume: 21, Issue: 3, Year: 2017

Keywords:

Dexmedetomidine , Anesthesia , General , Fentanyl , Cerebral relaxation score

References:

[1] .Relation between dexmedetomidine in awake craniotomy in adolescent: report of 2 cases, -

[2] TalkeP,LiJ,JainU,LeungJ,DrasnerK,HollenbergM,FieschiC,AgnoliA,BattistiniN,BozzaoL,PrencipeM., .Derangement of regional cerebral blood flow and of its regulatory mechanisms in acute cerebrovascular lesions,Neurology. 82 620 -3

[3] P.E.Tanskanen,KyttaJV,RandellTT,AantaaRE, 1968.dexmedetomidine as an anaesthetic adjuvant in patients undergoing intracranial tumor surgery: a double blind, randomized and placebo controlled study,Br J Anesth. 18 1166 -79

[4] SolimanRN,HasanAR,RashwanAM, ., 6 658 -65

[5] Middle East J Anesthesiol,ScheininB,LindgrenL,RandellT,ScheininH,ScheininM., 2011., 21 23 -33

[6] TakenakaM,IidaH,IidaM,Dohi S, 1992.Intrathecal dexmedetomidine attenuates hypercapnic but not hypoxic cerebral vasodilation in anesthetized rabbits,Anesthesiology. 68 126 -31

[7] BekkerAY,DoyleWK, 2005.Dexmedetomidine in awake craniotomy: a technical note,Surg Neurol 63 114 -6

[8] .Dexmedetomidine induced sedation in volunteers decreases regional and global cerebral blood flow,Anesth Analg 95 1052 -9

[9] EbertTJ,HallJE,BarneyJA,UhrichTD,ColincoMD, .The effects of increasing plasma concentrations of dexmedetomidine in humans., 10 -

[10] Anesthesiology,ShehabiY,RuettimannU,AdamsonH,InnesR,IckeringillM., .Dexmedetomidine infusion for more than 24 hours in critically ill patients: sedative and cardiovascular effects,Intensive Care Med 30 2188 -96

[11] HallJE,UhrichTD,BarneyJA,ShahbazRA,EbertTJ, 2000.Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions,Anesth Analg 90 699 -705

[12] AryanHE,Box KW IbrahimD,DesiraiuU,AmesCP, 2006.Safety and efficacy of dexmedetomidine in neurosurgical patients,Brain Inj 20 791 -8

Citations

Downloads

Views