Brain protective effect and hemodynamics of dexmedetomidine hydrochloride in patients with intracranial aneurysm

Abstract

Objective The purpose of the study was to investigate the effect of dexmedetomidine hydrochloride (Dex) on the recovery of cognitive function, hemodynamics, and postoperative analgesia in patients undergoing intracranial aneurysm craniotomy. Methods: general anesthesia was performed on patients undergoing intracranial aneurysm craniotomy in neurosurgery. Patients were randomly divided into three groups: Dex 1 group (Dex dose: 1 μg/kg), Dex 2 group (Dex dose: 0.5 μg/kg), and blank control group (normal saline). The changes of heart rate, arterial pressure, intraoperative brain function index, and postoperative pain score were recorded and compared. Results: in Dex 1 group and Dex 2 group, the heart rate of T1 and T2 phase was significantly lower than that of T3-T7 phases (P < 0.05); compared with the control group, the heart rate of Dex 1 group and Dex 2 group was significantly lower (P < 0.05). The average arterial pressure of the control group and Dex groups was significantly different (P < 0.05). Compared with the control group, there were significant differences between Dex 1 group and Dex 2 group: S100 β protein in T7-T10, NSE (neuron specific enolase) in T9 and T10, pain score in T8, T9 and T10 after operation. Conclusion: the application of Dex in the resection of intracranial aneurysms can protect the brain of patients, minimize the influence of operation on hemodynamics, and relieve postoperative pain, which is worthy of clinical application.

Effects of Intraoperative Dexmedetomidine Infusion on Postoperative Pain after Craniotomy: A Narrative Review

“…In the same trial, the group with the highest bolus dose of DEX was associated with a lower incidence of moderate-to-severe postoperative pain as compared to the group receiving the lowest bolus dose of DEX and the control group [ 20 ]. Similar results were detected in a trial by Zheng et al where the VAS scores for pain in both DEX groups were significantly reduced compared to the control group [ 25 ]. The improved analgesic and antinociceptive effects provided by DEX are described as resulting from inhibiting the up-regulation of pain signals by activating the posterior horn of the spinal cord and modulation of sympathetic response by releasing catecholamines [ 25 ].…”

“…Similar results were detected in a trial by Zheng et al where the VAS scores for pain in both DEX groups were significantly reduced compared to the control group [ 25 ]. The improved analgesic and antinociceptive effects provided by DEX are described as resulting from inhibiting the up-regulation of pain signals by activating the posterior horn of the spinal cord and modulation of sympathetic response by releasing catecholamines [ 25 ].…”

“…In four of these trials VAS was monitored every 5 min for the first 20 min then every 10 min for the rest of the time until the patients were discharged to the ward [ 17 , 21 , 22 , 24 ]. In the two remaining trials pain scores were assessed at 30, 60, 90 and 120 min, followed by 6, 12 and 24 h [ 25 , 26 ]. In one separate trial, the patient-controlled-analgesia was managed solely to provide opioids or other substances for patient analgesia and was discontinued when it was no longer needed by the patient [ 18 ].…”

“…Two trials reported postoperative pain intensity by assessing NRS scores [ 2 , 18 ]. Furthermore, six trials reported PACU pain intensity by assessing VAS score for pain [ 17 , 21 , 22 , 24 , 25 , 26 ]. An overview of the reported effects of DEX on postoperative pain in the included trials can be seen in Table 2 .…”

Effects of Dexmedetomidine on Perioperative Serum Potassium and Postoperative Rehabilitation of Patients Undergoing Radical Resection of Gastrointestinal Malignancy

“…A transient increase in blood pressure in a short period of time after dexmedetomidine use may be associated with its direct activation on alpha 2 -adrenergic receptors on vascular smooth muscle cells and leading to vasoconstriction, after which blood pressure drops with dexmedetomidine acting on the locus ceruleus, inhibiting the sympathetic nervous system excitation and also increasing the vagal excitability [13,14]. In the current study, it is noteworthy that MAP was signi cantly higher in group D 1 after dexmedetomidine loading dose nish compared to the control group, whereas there were no signi cant changes in MAP in group D 2 at this timepoint, which may be related to the higher basic MAP in the group D 1 than group D 2 .…”