BJA Advance Access originally published online on August 16, 2006
British Journal of Anaesthesia 2006 97(5):658-665; doi:10.1093/bja/ael220
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Dexmedetomidine as an anaesthetic adjuvant in patients undergoing intracranial tumour surgery: a double-blind, randomized and placebo-controlled study
1 Department of Anaesthesiology, Helsinki University Central Hospital Finland
2 Department of Anaesthesiology, Turku University Central Hospital Finland
*Corresponding author: Helsinki University Central Hospital, Topeliuksenkatu 5, 00260 Helsinki 26, Finland. E-mail: paivi.tanskanen{at}hus.fi
Background. Dexmedetomidine (DEX) has been shown to provide good perioperative haemodynamic stability with decreased intraoperative opioid requirements. It may have neural protective effects, and thus may be a suitable anaesthetic adjuvant to neurosurgical anaesthesia.
Methods. Fifty-four patients scheduled for elective surgery of supratentorial brain tumour were randomized to receive in a double-blind manner a continuous DEX infusion (plasma target concentration 0.2 or 0.4 ng ml–1) or placebo, beginning 20 min before anaesthesia and continuing until the start of skin closure. The DEX groups received fentanyl 2 µg kg–1 at the induction of anaesthesia and before the start of operation, the placebo group 4 µg kg–1, respectively. Anaesthesia was maintained with nitrous oxide in oxygen and isoflurane.
Results. The median times from the termination of N2O to extubation were 6 (3–27), 3 (0–20) and 4 (0–13) min in placebo, DEX-0.2 and DEX-0.4 groups, respectively (P<0.05 ANOVA all-over effect). The median percentage of time points when systolic blood pressure was within more or less than 20% of the intraoperative mean was 72, 77 and 85, respectively (P<0.01), DEX-0.4 group differed significantly from the other groups. DEX blunted the tachycardic response to intubation (P<0.01) and the hypertensive response to extubation (P<0.01). DEX-0.4 group differed in the heart rate variability from placebo (93 vs 82%, P<0.01).
Conclusions. DEX increased perioperative haemodynamic stability in patients undergoing brain tumour surgery. Compared with fentanyl, the trachea was intubated faster without respiratory depression.
The study has been presented as an abstract at Euroneuro 2002, September 13, 2002, Munich, Germany.
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