Background and Goal of Study:

Stability of hemodynamics, absence of hypertension or increased ICP level are extremely important for neurosurgical patients in the early postoperative period. According several studies alpha 2-adrenergic agonist can be used for hemodynamic stabilization during awakening and extubation [1]. Goal of this study was to compare effectiveness of short infusion of dexmedetomidine and clonidine in this clinical setting.

Materials and Methods:

In this prospective study we include 40 patients (from 18 y.o.) scheduled for elective craniotomy, ASA I-II. All patients were divided in two equal groups (D and C), 20 patients in each. During the dura mater closure in group D infusion of dexmedetomidine was started at a dose of 0.5 μg/kg/h, in the C group we used clonidine in a dose of 1 μg/kg/h. By the end of surgery, infusion was stopped and the patients with continuous hemodynamic monitoring were transferred to the PACU, where they were extubated. Hemodynamic parameters are measured on all these stages, as well as time to extubation, evaluation of the quality of awakening on the RASS and Aldrete scales, the presence of agitation during awakening.

Results and Discussion:

At the end of surgery before awakening we noted lower levels of mean arterial pressure (MAP) and heart rate (HR) in D group (63±10,2mmHg MAP; 70bpm HR in D group and 80±9,2mmHg MAP; 70bpm HR in C group). Immediately after extubation episodes of hypertension were noted in 1 patient in D group and in 2 patients in C group. In general after extubation: in D group MAP was 82±14 mmHg, HR - 75±15 bpm; in C group MAP - 90±11 mmHg, HR 77±12 bpm. MAP and HR after 10 minutes after extubation were 80±10 mmHg and 75±16 bpm in D group and 90±10 mmHg and 77±13 bpm in C group. Recovery profile was positive in both groups (9,4±1 points in Aldrete scale in both groups), all patients are calm based on RASS scale (-0,1±1,3 points in D group and -0,3±1,5 points in C group). 

Conclusion:

Both dexmedetomidine and clonidine were equally effective for prevention of hemodynamic instability at the emergence after anesthesia and extubation, even in form of short infusion. We noted rather high variability in time of extubation in both group, but positive profile of awakening without agitation and cough.

References:

1.    Turan G., Ozqultekin A., Turan C.,Advantageous effects of dexmedetomidine on haemodynamic and recovery responses during extubation for intracranial surgery. Eur. J. Anaesthesiol. 2008;

02 / Dexmedetomidine Vs Clonidine to prevent hemodynamic instability during emergence after craniotomy