The cerebral blood flow should be preserved by controlling the mean arterial pressure in acceptable cerebral perfusion pressure ranges during craniotomy. The author hypothesized that dexmedetomidine would attenuate hemodynamic changes during propofol induction, skull-pin application and skin incision in neurosurgical patients undergoing a craniotomy, compared with fentanyl.
Thirty patients (18–65 years), scheduled for elective intracranial surgery, received dexmedetomidine 1 μg/kg or fentanyl 2 μg/kg infusions before propofol based anesthesia. Propofol was started at 3.0 μg/ml on a target control syringe pump and titrated to maintain a similar level of sedation by using Bispectral index in both groups. The hemodynamic variables were continuously recorded and analyzed for the results.
Five minutes after induction with propofol, systolic pressure (Ps), diastolic pressure (Pd) and mean arterial pressure (MAP) were significantly higher in dexmedetomidine group. After that, MAP and HR in both groups increased after skull-pin fixation, but were not statistically significant. Ps, Pd and MAP in both groups increased slightly after the skin incision but all were not significantly different. The induction and total dose of propofol were not lower than those of fentanyl group, even though the dexmedetomidine group required less fentanyl intraoperatively, but there was no statistical difference.
Dexmedetomidine 1 μg/kg does not seem more effective than using fentanyl 2 μg/kg on blunting hemodynamic changes to propofol induction, tracheal intubation, skull-pin fixation, and skin incision in craniotomy patients.
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© 2012 European Society of Anaesthesiology