An Approach for Controlling Emergence Hypertension in Cranial Surgery Using Dexmedetomidine Infusion

Background: Systemic hypertension often accompanies emergence from anesthesia that may lead to serious neurologic, cardiovascular, or surgical-site complications and which requires urgent management Dexmedetomidine is a highly selective a2-adrenoceptor agonist with sedative, anxiolytic and analgesic properties that may prevent catecholamines release and development of hypertension.Patients and Methods: Patients scheduled for craniotomy for supratentorial tumors, were divided randomly into 2 equal groups with 25 patients in each group, both received standard anesthetic technique the rate of the infusion in both groups was 0.5ml/kg/hr and started after dural closure, Group D received dexmedetomidine infusion in a rate of (0.5m/kg/hr). Group C received normal saline infusion. Nitroglycerine at a dose starting from (1m/kg/min) added if systolic blood pressure exceeded 25% of its preinduction value. Haemodynamic parameters were recorded intra-and postoperatively, Number of patients needing nitroglycerine infusion in each group recorded together with total amount infused and time to extubation.Results: Dexmedetomine in a dose of 1m/kg/hr started after dural closure reduces the incidence and the extent of emergence hypertension as the number of patients needing nitroglycerin was 8 representing 32% of patients in dexmedetomidine group and 22 representing 88% of patients in control group without significant prolongation the time to extubation.Conclusion: Dexmedetomine in a dose of 1m/kg/hr started after dural closure had a significant effect in reducing the incidence and the extent of emergence hypertension without prolonging the time needed for extubation.