Effects of landiolol on systemic and cerebral hemodynamics and recovery from anesthesia in patients undergoing craniotomy.

PURPOSE

Maintenance of systemic and cerebral hemodynamics and quick recovery from anesthesia are required for craniotomy. We conducted a prospective randomized study to investigate the effects of continuous infusion of landiolol on hemodynamic responses to various stimuli, changes in systemic and cerebral hemodynamics during anesthesia, and recovery from anesthesia in patients undergoing craniotomy.

METHODS

Thirty patients undergoing elective craniotomy were randomly divided into two groups: a landiolol group and a control (saline) group. Landiolol was administered as an infusion rate of 0.125 mg/kg/min for 1 min, followed by an infusion at 0.01-0.04 mg/kg/min until 6 h after the end of anesthesia. Maximal values of heart rate (HR) and systolic blood pressure (SBP) in response to tracheal intubation, pin fixation, the beginning of operation, and extubation were compared between groups. Tissue oxygen index (TOI), mean arterial pressure (MAP), cardiac index (CI), and stroke volume index (SVI) before, during, and at the end of operation were compared between groups. Total doses of fentanyl, interval for the recovery from anesthesia, and incidence of postoperative nausea and vomiting (PONV) were also compared.

RESULTS

Maximal values of HR at intubation and pin fixation and of HR and SBP at extubation were significantly less in the landiolol group compared with those in the control group. TOI, MAP, CI, and SVI were similar between groups during anesthesia. Total doses of fentanyl were significantly less in the landiolol group than in the control group. Interval for recovery from anesthesia and incidence of PONV were similar between groups.

CONCLUSION

This study indicates that continuous infusion of landiolol suppressed hyperdynamic responses to stimuli during anesthesia while maintaining arterial blood pressure and cerebral oxygen balance during craniotomy. Although landiolol infusion did not affect recovery from anesthesia and incidence of PONV, it reduced intraoperative requirement of fentanyl.