The place of dexmedetomidine in the supratentorial craniotomies

IVABSTRACTTHE PLACE OF DEXMEDETOMIDINE IN THE SUPRATENTORIALCRANIOTOMIESDr. Osman ILHANResidency Thesis, Department of Anesthesiology and ReanimationSupervisor: Prof. Dr. Unsal ONERMay 2007, 63 PagesIn supratentorial craniotomies, we investigated the effects of fentanyl anddexmedetomidine as an adjuvant agent; on hemodynamic changes duringperioperative and recovery periods and their effectiveness of preventing thebrain edema perioperatively and recovery times and the effectiveness ofpreventing the side effects like hypertension, shivering, nause and vomiting.Thirty patients consenting ASA physical status I-II patients undergoingintracranial tumour surgery were randomly divided into two groups. Group D:Dexmedetomidine infusion. Group F: Fentanyl infusion. In group D,dexmedetomidine was infused 1 µg/kg at bolus dose 10 minutes beforeinduction of anesthesia. At induction fentanyl was given at 4 µg/kg dose ingroup D and at 2 µg/kg dose in group F. After induction; dexmedetomidine wasdosed with 0.2-0.7 µg/kg/min in group D, and with 0.02 µg/kg/min in group F asinfusion. Hemodynamic changes, recovery times and postoperative side effectswere recorded before induction,at the perioperative period and firstpostoperative 24 hours.In group D; MAP and HR values after intubation, after skull pin insertionand after extubation were low. And it was statiscally meaningful. In group D,brain relaxation scores were lower statistically. In group D, recovery times werefound short and it was statistically meaningful. In group D, supplemental opioidrequirement were lower. In group D at the postoperative period there were noshivering with cold, nause and vomiting but in group F 3 patients had thecomplaint of shivering with cold, and 2 patients had nause and vomiting.In our study, we found that dexmedetomidine controlled the hemodynamicchanges better than fentanyl perioperatively,after extubation and at the earlypostoperative period.We believe that, dexmedetomidine is more safety and more effective tocontrol the hemodynamic changes against the surgical stimulans than thestandart agents in neurosurgery.Key Words: Supratentorial craniotomy, Dexmedetomidine, Hemodynamicresponse, Brain edema