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BJA Advance Access published online on August 16, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael220
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted June 29, 2006

Clinical Investigation

Dexmedetomidine as an anaesthetic adjuvant in patients undergoing intracranial tumour surgery: a double-blind, randomized and placebo-controlled study{dagger}

P. E. Tanskanen 1 *, J. V. Kyttä 1, T. T. Randell 1, and R. E. Aantaa 2

1 Department of Anaesthesiology, Helsinki University Central Hospital, Finland
2 Department of Anaesthesiology, Turku University Central Hospital, Finland

* To whom correspondence should be addressed.
P. E. Tanskanen, E-mail: paivi.tanskanen{at}hus.fi


  Abstract

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.

Keywords: {alpha}2-agonists, dexmedetomidine; anaesthesia, general; neurosurgical procedures, craniotomy.
{dagger}The study has been presented as an abstract at Euroneuro 2002, September 13, 2002, Munich, Germany.
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