Comparison of remifentanil with esmolol to blunt the cardiovascular response to tracheal extubation in patients undergoing neurosurgical procedures for intracranial masses

Objective: To compare the efficacy of esmolol with remifentanil in maintaining haemodynamic stability at the end of a neurosurgical procedure and recovery stages and reducing the length of the recovery phase. Methods: The double-blind prospective randomised clinical trial was conducted at Imam Reza Hospital, Tabriz, Iran, from May 2010 to November 2011. It comprised 90 adult patients who were scheduled to undergo elective neurosurgery operations and were randomly divided into three groups receiving esmolol, remifentanil and placebo for 14 minutes. The intravenous infusion was started four minutes prior to extubation and continued for 10 minutes after extubation. SPSS 16 was used for statistical analysis. Results: There was a significant difference between the three groups regarding the changes of mean arterial pressure after extubation and five minutes after extubation (p 0.001 in all groups). The esmolol group compared with the placebo group and the remifentanil group compared with control group were of significant difference at all heart rate values after extubation (p 0.001 in all cases). A significant difference regarding SaO2 levels was observed between the remifentanil and esmolol groups 5 (p 0.01), 10 (p 0.01) and 15 minutes after extubation (p 0.005). Conclusion: Both esmolol and remifentanil can be used in preventing hyperdynamic status throughout the extubation phase without extending the recovery phase. However, due to more frequent respiratory suppression and prolonged extubation observed in the remifentanil group, its administration should be done with caution.