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

 Hyunzu Kim  ;  Kyeong Tae Min  ;  Jeong Rim Lee  ;  Sang Hee Ha  ;  Woo Kyung Lee  ;  Jae Hee Seo  ;  Seung Ho Choi 
 YONSEI MEDICAL JOURNAL, Vol.57(4) : 980-986, 2016 
Journal Title
Issue Date
Adult ; Aged ; Airway Extubation ; Anesthesia Recovery Period* ; Cough/drug therapy ; Craniotomy*/adverse effects ; Dexmedetomidine/pharmacology* ; Dexmedetomidine/therapeutic use ; Double-Blind Method ; Female ; Hemodynamics/drug effects* ; Humans ; Male ; Middle Aged ; Piperidines/pharmacology* ; Piperidines/therapeutic use ; Prospective Studies ; Reflex/drug effects* ; Respiratory System/blood supply ; Respiratory System/drug effects* ; Respiratory System/physiopathology ; Young Adult
Anesthesia recovery period ; craniotomy ; dexmedetomidine ; remifentanil
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.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Min, Kyeong Tae(민경태) ORCID logo https://orcid.org/0000-0002-3299-4500
Lee, Woo Kyung(이우경)
Lee, Jeong Rim(이정림) ORCID logo https://orcid.org/0000-0002-7425-0462
Choi, Seung Ho(최승호) ORCID logo https://orcid.org/0000-0001-8442-4406
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