Effect Of Dexmedetomidine On Hemodynamics During Intracranial Aneurysms Interventional Surgery

Objective: Interventional neurosurgery of intracranial aneurysms is widely carried out for its minimally invasive. It has become a major change of intracranial aneurysms because of its fast, accurate positioning, minimal trauma and significant effect. This kind of surgery need stable hemodynamics during the perioperative period, and it requires the patient to fit the neurological examination in anesthesia recovery period. Previously interventional neurosurgery of intracranial aneurysms used mostly remifentanil anesthesia with sevoflurane inhalation. This combination which has strong inhibition to surgical stress, is widely used in various types of surgery. Remifentanil has the short term and strong analgesic effect advantages, but its effect disappears quickly, the pain occurs early, which can cause irritability, even resulting in cardiovascular system accidents. Sevoflurane can make hemodynamics more stable, reduce the amount of muscle relaxants, and make postoperative recovery quickly and thoroughly. However the disadvantage is proning to agitation for recovery. It has been confirmed that dexmedetomidine hydrochloride, which is applied with general anesthesia, can reduced the dosage of sedative, analgesic drugs, reduce adverse effects and improve the quality of anesthesia, and there is no respiratory depression. On the premise of keeping the patients consciousness, dexmedetomidine hydrochloride can provide adequate analgesia, sedation and anxiolytic effects, and ensure the successful completion of required neurological examination. In the anesthesia recovery period, it can reduce the body’s stress level for adverse stimuli, enhance cardiovascular stability, and improve anesthesia recovery process. This study was to observe its feasibility that dexmedetomidine hydrochloride combinded sevoflurane anesthesia for interventional neurosurgery of intracranial aneurysm.Methods:According to different kinds of anesthesia maintain drugs, 40 patients all accept intracranial aneurysm embolization were randomly divided into group R(remifentanil) and group D(dexmedetomidine hydrochloride). Inclusion criteria:(1)patients diagnosed intracranial aneurysm by the whole brain MRI or angiography will be accepted interventional neurosurgery of intracranial aneurysms(2) ASA score of II-III patients.Intravenous fluid infused after entering the operation room. ECG, noninvasive blood pressure, and oxygen saturation(SPO2) were monitored routinely. Midazolam 0.05mg/kg, sufentanil 0.3ug/kg, cisatracurium 0.2mg/kg, and etomidate 0.15mg/kg were used for anesthesia induction. Maintenance of Anesthesia included group D with 2-3% sevoflurane inhalation combined with dexmedetomidine hydrochloride given by continuous infusion(loading dose using 0.5ug/kg/10 min, maintenance dose using 0.4ug/kg/h); Group R using 2-3%sevoflurane inhalation combined with remifentanil 0.1-0.2ug/kg/min continuous infusion, administered intermittently along atracurium maintain muscle relaxants. End-tidal carbon dioxide(Pet CO2) was maintained between 35-45 mm Hg in surgery, BIS monitoring values between 40-60. Recorded before induction of anesthesia(T0), after the completion of intubation(T1), given dexmedetomidine hydrochloride infusion 15min(T2), hydrochloric acid dexmedetomidine infusion set 30min(T3) and at the end of surgery(T4) when Patients’ systolic blood pressure, diastolic and mean arterial pressure, heart rate and oxygen saturation values. During anesthesia recovery period, according to riker sedation and agitation score(SAS) hemodynamic data were recorded including with tubation tolerance(S1), the instruction with(S2), extubation(S3) and the leaving from operation room(S4). Numerical and cough scores, and extubation time was recorded in each group.Results:1 There was no significant difference(P>0.05) between the two groups of general conditions.2 The compare hemodynamic parameters in the maintenance phase of anesthesia: T0 point MAP and HR had no significant differences between two groups. At T1, T2, T3 and T4 point, MAP in dexmedetomidine group were higher than those given remifentanil group(P<0.05). At the same time point HR values in dexmedetomidine group was significantly lower(P<0.05) than that in remifentanil group.3 Hemodynamic parameters comparation in anesthesia recovery period, at S1, S2, S3 and S4 time, MAP in dexmedetomidine group was lower than that in remifentanil group(P<0.05). Compared with baseline values, changes in the magnitude of MAP and HR was significantly lower than that in remifentanil group(P<0.05).4 In recovery period, riker sedation and agitation score(SAS) in dexmedetomidine group was significantly lower than that in remifentanil group(P<0.05).5 Extubation time in dexmedetomidine group was significantly longer than that in remifentanil group(P<0.05).6 The incidence of cough in dexmedetomidine group was significantly lower than that in remifentanil group(P<0.05). The cough scores was not statistically significant between two groups(P>0.05).Conclusions:1 Dexmedetomidine hydrochloride can maintain hemodynamic stability during general anesthesia, and maintain better tissue perfusion. For patients with hypertension whose set-point of baroreflex has already been up to maintain a higher level of perfusion pressure during surgery, can avoid hypoxic ischemic injury during anesthesia administration.2 Dexmedetomidine hydrochloride has stable hemodynamics in general anesthesia recovery period, and restlessness score lower. Reduce severe stress response with anesthesia effects disappear.