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

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.

Keywords: Anesthesia recovery period; craniotomy; dexmedetomidine; remifentanil.

Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

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.