| Prospective, randomized controlled study to assess the role of dexmedetomidine in patients with supratentorial tumors undergoing craniotomy under general anesthesia. | |
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MedLine Citation:
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PMID: 21991729 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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BACKGROUND: Preliminary data on the perioperative use of dexmedetomidine in patients undergoing craniotomy for brain tumor under general anesthesia indicate that the intraoperative administration of dexmedetomidine is opioid-sparing, results in less need for antihypertensive medication, and may offer greater hemodynamic stability at incision and emergence. Dexmedetomidine, alpha 2 adrenoceptor agonist, is used as adjuvant to anesthetic agents. Relatively recent studies have shown that dexmedetomidine is able to decrease circulating plasma norepinephrine and epinephrine concentration in approximately 50%, decreases brain blood flow by directly acting on post-synaptic alpha 2 receptors, decreases CSF pressure without ischemic suffering and effectively decreases brain metabolism and intracranial pressure and also, able to decrease injury caused by focal ischemia. PURPOSE: This prospective, randomized, double-blind study was designed to assess the perioperative effect of intraoperative infusion of dexmedetomidine in patients with supratentorial tumors undergoing craniotomy under general anesthesia. METHODS: Fourty patients with CT- scanning proof of supratentorial tumors were classified equally into 2 groups (twenty patients in each group). Group A:--Dexmedetomidine was given as a bolus dose of 1 microg/kg in 20 minutes before induction of anesthesia, followed by a maintenance infusion of 0.4 microg/kg/hr. The infusion was discontinued when surgery ended. Group B:--The patients received similar volumes of saline. RESULTS: Heart rate and mean arterial blood pressure, decreased significantly in patients of group A (dexmedetomidine group) compared to group B (placebo group) (p-value < 0.05). There was no significant statistical difference between the two groups regarding the central venous pressure and arterial partial pressure of carbon dioxide (p-value > 0.05). The intraoperative end-tidal sevoflurane (%) in patients of group A was less than in patients of group B (p-value < 0.05). The intracranial pressure decreased in patients of Group A more than group B (p-value < 0.05). The Glasgow coma scale (GCS) improved in patients of group A and deteriorated in patients of Group B with significant statistical difference between the two groups (p-value < 0.05). The total fentanyl requirements from induction to extubation of patients increased in patients of group B more than in patients of group A (p-value < 0.05). The total postoperative patients' requirements for antiemetic drugs within the 2 hours after extubation decreased in patients of group A more than group B (p-value < 0.05). The postoperative duration from the end of surgery to extubation decreased significantly in patients of group A more than group B (p-value < 0.05). The total urine output during the duration from drug administration to extubation of patients increased in patients of group A more than group B (p-value < 0.05). CONCLUSION: Continuous intraoperative infusion of dexmedetomidine during craniotomy for supratentorial tumors under general anesthesia maintained the hemodynamic stability, reduced sevoflurane and fentanyl requirements, decreased intracranial pressure, and improved significantly the outcomes. |
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Authors:
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Rabie Nasr Soliman; Amira Refaie Hassan; Amr Madih Rashwan; Ahmed Mohamed Omar |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Middle East journal of anesthesiology Volume: 21 ISSN: 0544-0440 ISO Abbreviation: Middle East J Anesthesiol Publication Date: 2011 Feb |
Date Detail:
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Created Date: 2011-10-13 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8604187 Medline TA: Middle East J Anesthesiol Country: Lebanon |
Other Details:
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Languages: eng Pagination: 23-33 Citation Subset: IM |
Affiliation:
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Department of Anaesthesia and Neurosurgical ICU, Faculty of Medicine, Cairo University, Egypt. rabiesoliman@hotmail.com |
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