A randomized control study of dexmedetomidine versus fentanyl as an anesthetic adjuvant in supratentorial craniotomies

Abstract

Introduction: Dexmedetomidine provides stable perioperative hemodynamic profile with decreased requirement of opioids. It has neuroprotective effect and may be suitable anesthetic adjuvant when compared to fentanyl.

The main aim of our study was to compare dexmedetomidine and fentanyl in relation to blunting of sympathetic response to intubation and induction while secondary variables were to study their effect on perioperative hemodynamic changes, operative conditions, recovery profile and side effects.

Methodology: In this double blind randomized control trial 50 patients of ASA I and II grade scheduled for elective neurosurgery were selected over a period of 1 year, after obtaining written informed consent. Patients were randomly divided into two groups; in Group-D patient received 1 µg/kg of dexmedetomidine as loading dose within 10 min before induction and 2 µg/kg of fentanyl at induction and 0.04-0.05 µg/kg/min of dexmedetomidine as maintenance during surgery. In Group-F patient received induction with 3 µg/kg of fentanyl and maintained with 0.02-0.03 µg/kg/min of fentanyl.

Hemodynamic changes, cerebral relaxation store, recovery time and intraoperative and postoperative side effects were noted

Results: Baseline heart rate and BP was similar in both the groups. In Group-D and F, Heart rate and BP were increased from baseline during intubation, skull clamping and extubation but were within physiological limits. The rise in heart rate and BP was comparatively lower in Group-D as compared to Group-F. all the values were statistically significant (p < 0.05)

Cerebral relaxation score was lower in Group-D as compared to Group-F, along with faster recovery. During postoperative period there was no shivering nausea and vomiting in Group-D but in Group-F, 1 patient experienced shivering while 2 patients complained of nausea and vomiting.

Conclusion: In our study we found that dexmedetomidine provided better hemodynamic profile as compared to fentanyl with better cerebral relaxation score and recovery time. Hence we conclude that dimetindene is safer and effective alternate to fentanyl as an anesthetic adjuvant in neurosurgery.