Sruthy Unni1, Ranju Sebastian2, Elizabeth Joseph3, Remani Kelan Kamalakshi4, Jamsheena Muthira Parambath5
BACKGROUND
Anaesthesia for neurosurgery requires special considerations. The brain is
enclosed in a rigid cranium, so the rise in intracranial pressure (ICP) which impairs
cerebral perfusion pressure (CPP), results in irrepairable damage to various vital
areas in the brain. Stable head position is required in long neurosurgical
procedures. This is obtained with the use of clamps which fix the head rigidly. This
is done usually under general anaesthesia because it produces intense painful
stimuli leading to stimulation of sympathetic nervous system which in turn causes
release of vasoconstrictive agents. This can impair perfusion in all organ systems.
The increase in blood pressure due to sympathetic nervous system causes increase
in blood flow. This causes increases in intracranial pressure which result in
reduction in cerebral perfusion pressure once the auto regulatory limits are
exceeded. We compared the effects of dexmedetomidine 1 μgm/kg and propofol
100 μgm/kg given as infusion over a period of 10 minutes before the induction of
anaesthesia and continued till 5 minutes after pinning to attenuate the stress
response while cranial pinning. In this study, we wanted to compare the effects of
dexmedetomidine and propofol as infusion to attenuate the stress response while
cranial pinning in patients undergoing neurosurgical procedures.
METHODS
This is a randomized interventional trial. Patients were divided into 2 groups of 20
each. Group 1 receiving dexmedetomidine and group 2 receiving propofol, both
drugs given as infusion. Haemodynamic variables were monitored before and after
cranial pinning. Data was analysed using IBM statistical package for social sciences
(SPSS) statistics. The parameters recorded were analysed with the help of a
statistician.
RESULTS
The two groups were comparable in demographic data. Incidence of tachycardia
between group 1 and 2 showed that tachycardia to pinning was better controlled
with propofol than dexmedetomidine (P < 0.05) which is statistically significant.
There is no statistically significant difference in blood pressure values between
group 1 and 2 after pinning.
CONCLUSIONS
From our study, we came to a conclusion that propofol was superior to
dexmedetomidine in attenuating the heart rate response to cranial pinning. The
effect of propofol and dexmedetomidine was comparable in attenuating the blood
pressure response to cranial pinning.
