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Advantageous effects of dexmedetomidine on haemodynamic and recovery responses during extubation for intracranial surgery

Published online by Cambridge University Press:  01 October 2008

G. Turan ,
A. Ozgultekin ,
C. Turan ,
E. Dincer  and
G. Yuksel
G. Turan*
Affiliation:
Haydarpasa Numune Teaching and Research Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey
A. Ozgultekin
Affiliation:
Haydarpasa Numune Teaching and Research Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey
C. Turan
Affiliation:
Haydarpasa Numune Teaching and Research Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey
E. Dincer
Affiliation:
Haydarpasa Numune Teaching and Research Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey
G. Yuksel
Affiliation:
Haydarpasa Numune Teaching and Research Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey
*
Correspondence to: Guldem Turan, Barbaros Mahallesi Veysi Paşa Sokak 2/1, Atayurt Sitesi A Blok Daire: 16, Üsküdar/Istanbul 34662, Turkey. E-mail: gturanmd@yahoo.com; Tel: +90 2164746304; Fax: +90 2163460582
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Summary

Background and objective

The anaesthetic method for intracranial neurosurgery must provide haemodynamic stability on emergence and allow early evaluation of the neurological status. In this study, we examined the effects of the α-2 agonist dexmedetomidine given at the end of the procedure to prevent hyperdynamic responses during extubation and to allow a comfortable and high-quality recovery.

Methods

Forty ASA I–III patients, aged between 18 and 75 yr, having elective intracranial surgery, were divided into two random groups. Standard procedures and drugs were used for monitoring, induction and maintenance. Isoflurane was reduced by 50% 5 min before the end of the surgery, and in Group I dexmedetomidine 0.5 μg kg−1 and in Group II 20 mL of 0.9% NaCl were administrated intravenously over 60 s. Systolic, diastolic and mean arterial pressures, and heart rate were recorded before intravenous administration and also at 1, 3 and 5 min after administration, 1 min before extubation, during extubation, 1, 3, 5, 10, 15, 20 and 30 min after extubation. Duration of extubation and recovery were noted, and the quality of extubation was evaluated on a 5-point scale.

Results

Mean arterial pressure and heart rate were significantly higher in Group II than in Group I (P < 0.01). There were no statistically significant differences between groups regarding the duration of extubation and recovery (P > 0.05). Extubation quality score of all the patients were 1 in Group I; and in Group II, the quality scores were 1 for 35%, 2 for 45% and 3 for 20% of the patients (P < 0.001). None of the patients in Group I and Group II showed respiratory depression, nausea or vomiting.

Conclusion

Without interfering in recovery time, dexmedetomidine 0.5 μg kg−1 administered 5 min before the end of surgery stabilizes haemodynamics, allows easy extubation, provides a more comfortable recovery and early neurological examination following intracranial operations.

Keywords

DEXMEDETOMIDINEPRESSURE INTRACRANIALNEUROSURGERY, intracranialINTUBATION INTRATRACHEAL, extubationCARDIOVASCULAR PHYSIOLOGY
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 10 , October 2008 , pp. 816 - 820
Copyright
Copyright © European Society of Anaesthesiology 2008

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References

1.Miller, KA, Harkin, CP, Bailey, PL. Postoperative tracheal extubation. Anesth Analg 1995; 80: 149–172.Google Scholar
2.Nishina, K, Mikawa, K, Shiga, M, Maekawa, N, Obara, H. Prostaglandin E1 attenuates the hypertensive response to tracheal extubation. Can J Anaesth 1996; 43: 678–683.Google Scholar
3.Basali, A, Mascha, EJ, Kalfas, I, Schubert, A. Relation between perioperative hypertension and intracranial haemorrhage after craniotomy. Anaesthesiology 2000; 93: 48–54.CrossRefGoogle ScholarPubMed
4.Bruder, N, Stordeur, J-M, Ravussin, P et al. Metabolic and haemodynamic changes during recovery and tracheal extubation in neurosurgical patients: immediate versus delayed recovery. Anesth Analg 1999; 89: 674–678.Google Scholar
5.Hall, JE, Uhrich, TD, Barney, JA, Shahbaz, RA, Ebert, TJ. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg 2000; 90: 699–705.CrossRefGoogle ScholarPubMed
6.Bekker, A, Sturaitis, MK. Dexmedetomidine for neurosurgical surgery. Neurosurg Online 2005; 57: 1–10.Google Scholar
7.Khan, ZP, Munday, IT, Jones, RM, Thornton, C, Mant, TG, Amin, D. Effects of dexmedetomidine on isoflurane requirements in healthy volunteers: pharmacodynamic and pharmacokinetic interactions. Br J Anaesth 1999; 83: 372–380.CrossRefGoogle ScholarPubMed
8.Maze, M, Scarfini, C, Cavaliere, F. New agents for sedation in the intensive care unit. Crit Care Med 2003; 18: 29–41.Google Scholar
9.Talke, P, Chen, R, Thomas, B et al. The haemodynamic and adrenergic effects of perioperative dexmedetomidine infusion after vascular surgery. Anesth Analg 2000; 90: 834–839.CrossRefGoogle ScholarPubMed
10.Ebert, TJ, Hall, JE, Barney, JA, Uhrich, TD, Colinco, MD. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anaesthesiology 2000; 93: 382–394.Google Scholar
11.Bekker, AY, Basile, J, Gold, M et al. Dexmedetomidine for awake carotid endarterectomy: efficacy, hemodynamic profile, and side effects. Neurosurg Anesthesiol 2004; 16: 126–135.CrossRefGoogle ScholarPubMed
12.Lawrence, CJ, De Lange, S. Effects of a single pre-operative dexmedetomidine dose on isoflurane requirements and peri-operative hemodynamic stability. Anaesthesia 1997; 52: 736–744.Google Scholar
13.Guler, G, Akın, A, Tosun, Z, Eskıtascoglu, E, Mızrak, A, Boyacı, A. Single-dose dexmedetomidine attenuates airway and circulatory reflexes during extubation. Acta Anaesthesiol Scand 2005; 49: 1088–1091.CrossRefGoogle ScholarPubMed
14.Tanskanen, PE, Kytta, JV, Randell, TT, Aantaa, RE. Dexmedetomidine as an anaesthetic adjuvant in patients undergoing intracranial tumour surgery: a double-blind, randomised and placebo-controlled study. Br J Anaesth 2006; 5: 658–665.CrossRefGoogle Scholar
15.Guler, G, Akın, A, Tosun, Z, Eskitaşçıoglu, E, Mızrak, A, Boyacı, A. The effects of Dexmedetomidine on the cardiovascular responses to tracheal extubation and quality of tracheal extubation in elderly patients undergoing cataract surgery. J Turk Anaesthesiol Intensive Care Soc 2005; 33: 18–23.Google Scholar
16.Bloor, BC, Ward, DS, Belleville, JP et al. Effects of intravenous dexmedetomidine in humans 2. Hemodynamic changes. Anaesthesiology 1992; 77: 1134–1142.CrossRefGoogle ScholarPubMed
17.Martin, E, Ramsey, G, Mantz, J, Sum-Ping, ST. The role of the alfa-2 adrenoceptor agonists dexmedetomidine in postsurgical sedation in the intensive care unit. J Intensive Care Med 2003; 18: 29–41.CrossRefGoogle Scholar
18.Venn, RM, Hell, J, Grounds, RM. Respiratory effects of dexmedetomidine in the surgical patient requiring intensive care. Crit Care 2000; 4: 302–308.Google Scholar
19.Shehabi, Y, Ruettimann, U, Adamson, H, Innes, R, Ickeringill, M. Dexmedetomidine infusion for more than 24 hours in critically ill patients: sedative and cardiovascular effects. Intensive Care Med 2004; 30: 2188–2196.Google Scholar