Yonsei Med J.  2016 Jul;57(4):980-986. 10.3349/ymj.2016.57.4.980.

Comparison of Dexmedetomidine and Remifentanil on Airway Reflex and Hemodynamic Changes during Recovery after Craniotomy

• Kim H
• Min KT
• Lee JR
• Ha SH
• Lee WK
• Seo JH
• Choi SH

• KMID: 2374133
• DOI: http://doi.org/10.3349/ymj.2016.57.4.980

Abstract

PURPOSE
During emergence from anesthesia for a craniotomy, maintenance of hemodynamic stability and prompt evaluation of neurological status is mandatory. The aim of this prospective, randomized, double-blind study was to compare the effects of dexmedetomidine and remifentanil on airway reflex and hemodynamic change in patients undergoing craniotomy.
MATERIALS AND METHODS
Seventy-four patients undergoing clipping of unruptured cerebral aneurysm were recruited. In the dexmedetomidine group, patients were administered dexmedetomidine (0.5 µg/kg) for 5 minutes, while the patients of the remifentanil group were administered remifentanil with an effect site concentration of 1.5 ng/mL until endotracheal extubation. The incidence and severity of cough and hemodynamic variables were measured during the recovery period. Hemodynamic variables, respiration rate, and sedation scale were measured after extubation and in the post-anesthetic care unit (PACU).
RESULTS
The incidence of grade 2 and 3 cough at the point of extubation was 62.5% in the dexmedetomidine group and 53.1% in the remifentanil group (p=0.39). Mean arterial pressure (p=0.01) at admission to the PACU and heart rate (p=0.04 and 0.01, respectively) at admission and at 10 minutes in the PACU were significantly lower in the dexmedetomidine group. Respiration rate was significantly lower in the remifentanil group at 2 minutes (p<0.01) and 5 minutes (p<0.01) after extubation.
CONCLUSION
We concluded that a single bolus of dexmedetomidine (0.5 µg/kg) and remifentanil infusion have equal effectiveness in attenuating coughing and hemodynamic changes in patients undergoing cerebral aneurysm clipping; however, dexmedetomidine leads to better preservation of respiration.

Keyword

Anesthesia recovery period; craniotomy; dexmedetomidine; remifentanil

MeSH Terms

Adult
Aged
Airway Extubation
*Anesthesia Recovery Period
Cough/drug therapy
*Craniotomy/adverse effects
Dexmedetomidine/*pharmacology/therapeutic use
Double-Blind Method
Female
Hemodynamics/*drug effects
Humans
Male
Middle Aged
Piperidines/*pharmacology/therapeutic use
Prospective Studies
Reflex/*drug effects
Respiratory System/blood supply/*drug effects/physiopathology
Young Adult
Dexmedetomidine
Piperidines

Figure

• 

  Fig. 1 Cough profile at the point of awareness (A) and extubation (B) for the dexmedetomidine group (□) and remifentanil group (▪). Grade of cough: 0=no cough, 1=mild (single) cough, 2=moderate (≤5 s) cough, 3=severe (>5 s) cough.

• 

  Fig. 2 Changes in mean arterial pressure and heart rate during recovery for the dexmedetomidine group (•) and remifentanil group (□). *p<0.05 between groups. T1, 5 minutes before end of surgery; T2, at termination of sevoflurane; T3, at awareness; T4, at extubation; T5, 2 minutes after extubation; T6, 5 minutes after extubation; T7, at admission to PACU; T8, 10 minutes in PACU. PACU, post-anesthetic care unit.

• 

  Fig. 3 Changes in respiration rate after extubation for the dexmedetomidine group (•) and remifentanil group (□). *p<0.05 between groups. T5, 2 minutes after extubation; T6, 5 minutes after extubation; T7, at admission to PACU; T8, 10 minutes in PACU. PACU, post-anesthetic care unit.

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