Uyar Ahmet Senol, Yagmurdur Hatice, Fidan Yasemin, Topkaya Cigdem, Basar Hulya
Clinic of Anesthesiology and Reanimation, The Ministry of Health Ankara Research and Training Hospital, Ankara, Turkey.
J Neurosurg Anesthesiol. 2008 Jul;20(3):174-9. doi: 10.1097/ANA.0b013e318177e5eb.
We tested dexmedetomidine, an alpha2 agonist, for its ability to decrease heart rate, arterial blood pressure, and neuroendocrinal responses to skull-pin head-holder application during craniotomy. In a randomized, double-blinded, placebo-controlled study, 40 patients undergoing craniotomy with attachment of a pin head-holder were randomly assigned to one of 2 equal groups. The placebo group received saline, whereas the treatment group (DEX group) received a single bolus dose of dexmedetomidine (1 microg/kg) intravenously over 10 minutes before induction of anesthesia. Arterial blood pressure, heart rate, and sequential concentrations of circulating cortisol, prolactin, insulin, and blood glucose were measured. Relative to baseline and the other group, arterial blood pressure and heart rate decreased significantly after the administration of dexmedetomidine through skull pinning (P<0.05). In the placebo group, patients' heart rate and arterial blood pressure measures increased at 1 and 5 minutes after skull-pin insertion, compared with baseline and the DEX group (P<0.05). In both groups, plasma cortisol, prolactin, and blood glucose increased significantly relative to baseline after skull-pin insertion. However, the values were significantly higher in the placebo group compared with the DEX group (P<0.05). Although insulin levels were not significantly altered in the DEX group, the plasma concentrations of insulin decreased significantly after pin insertion in the placebo group. Our results suggested that, a single bolus dose of dexmedetomidine before induction of anesthesia attenuated the hemodynamic and neuroendocrinal responses to skull-pin insertion in patients undergoing craniotomy.
我们测试了α2激动剂右美托咪定，观察其在开颅手术期间降低心率、动脉血压以及对颅骨针式头架应用的神经内分泌反应的能力。在一项随机、双盲、安慰剂对照研究中，40例行颅骨针式头架固定开颅手术的患者被随机分为2个相等的组。安慰剂组给予生理盐水，而治疗组（DEX组）在麻醉诱导前10分钟静脉注射单次推注剂量的右美托咪定（1微克/千克）。测量动脉血压、心率以及循环皮质醇、催乳素、胰岛素和血糖的连续浓度。与基线和另一组相比，通过颅骨针给予右美托咪定后，动脉血压和心率显著降低（P<0.05）。在安慰剂组中，与基线和DEX组相比，患者在颅骨针插入后1分钟和5分钟时的心率和动脉血压测量值升高（P<0.05）。在两组中，颅骨针插入后血浆皮质醇、催乳素和血糖相对于基线均显著升高。然而，安慰剂组的值与DEX组相比显著更高（P<0.05）。虽然DEX组胰岛素水平无显著变化，但安慰剂组在针插入后血浆胰岛素浓度显著降低。我们的结果表明，麻醉诱导前单次推注剂量的右美托咪定可减轻开颅手术患者对颅骨针插入的血流动力学和神经内分泌反应。
