Comparison of the effects of urapidil and remifentanil on extubation hemodynamic changes and extubation quality in intracranial mass surgery

Objective: In this study, we aimed to compare the effects of selective α-1 antagonist urapidil and remifentanil on hemodynamic changes during extubation and extubation quality in patients undergoing intracranial surgery. Material and Method: The study included 90 patients aged 18-65 years with ASA scores I-II who underwent intracranial surgery. Patients who underwent sevoflurane-remifentanil anesthesia following induction of anesthesia with propofol rocuronium were divided into three groups 15 minutes before extubation. In Group I, remifentanil infusion was reduced to a dose of 0.02-0.03 μg/kg/min for the last 15 minutes and discontinued with extubation. In Group II, bolus urapidil (12.5 mg) was given 5 min after remifentanil infusion was stopped in the last 15 min and uradipil infusion (3.2.-4.8 μg/kg/min) was administered until extubation. In Group III, remifentanil infusion was discontinued for the last 15 min and uradipil infusion (3.2-4.8 μg/kg/min) was administered immediately until extubation. In all patients, in the last 15 minutes of the operation and in the first 5 minutes after extubation, the extubation time and the operation time were recorded with vital parameters. Entropy values along with vital parameters were also recorded to assess the effect of drugs on wakefulness. Results: There was no significant difference between the groups in terms of demographic findings, extubation time and operative time (p>0.05). The mean of basal SAB, OAB and DAB values in Group I was lower than the average of SAB, OAB, DAB values in 0., 1., 3 and 5 minutes after extubation. The mean of SAB, OAB, DAB baseline values in groups II and III were higher than the mean of SAB, OAB, DAB values in 0., 1., 3 and 5 minutes after extubation. There was no difference between the groups in terms of entropy values. The quality of extubation was similar in the groups Conclusion: With this study, it was concluded that urapidil administration initiated before extubation and applied with two different methods (bolus + infusion or alone infusion) in patients undergoing intracranial surgery provided better control of hemodynamic response during extubation compared to low dose remifentanil administration (0.2-0.3 μg/kg/min) and did not affect wakefulness at the doses administered.