A comparison of the effects of urapidil and remifentanil on hemodynamics and extubation quality in intracranial surgery

Abstract

Giriş: Serebral perfüzyon basıncını azaltmak ve kanama riskini en aza indirmek için uyanma sırasında stabil hemodinamiği korumak oldukça önemlidir. Urapidil ve remifentanilin ekstübasyon kalitesi ve ekstübasyon sırasında hemodinami üzerindeki etkilerini karşılaştırmayı amaçladık. Materyal ve Metod: 18-65 yaş aralığında, ASA 1-3 dahil 90 hasta çalışmaya dahil edildi. Anestezi tüm gruplarda remifentanil 0,125-0,25 µg/kg/dk ve sevofluran %1-2 ile sürdürüldü. Grup I' de remifentanil infüzyonu ameliyatın son 15 dakikasında 0,02-0,03 µg/kg/dk' ya düşürüldü. Grup II' de remifentanil infüzyonu ameliyatın bitiminden 15 dakika önce durduruldu. 5 dakika sonra, urapidil bolus dozu (12,5 mg) verildi ve urapidil infüzyonu (3,2-4,8 μg/kg/dak) başlatıldı. Grup III'te, remifentanil infüzyonu ameliyatın bitiminden 15 dakika önce durduruldu ve urapidil infüzyonu (3,2-4,8 μg/kg/dak) başlatıldı. Hemodinamik veriler, entropi değerleri ve Glasgow Koma Skalası, son 15. dakikada ve ekstübasyondan sonraki 5. dakikaya kadar kaydedildi. Bulgular: Ekstübasyondan önce ve sonra SAP (sistolik arter basıncı), MAP (ortalama arter basıncı) ve DAP (diyastolik arter basıncı) ortalama değerleri arasında istatistiksel olarak anlamlı farklar gözlendi (p<0,05). Grup I'de, başlangıçtaki SAP, MAP ve DAP ortalama değerleri, ekstübasyondan sonraki 1-3 ve 5. dakikalardaki ortalama değerlerden düşüktü. Grup II-III'te, başlangıçtaki SAP, MAP ve DAP, ekstübasyondan 1-3-5 dakika sonraki değerlerden daha yüksekti. Sonuç: Hem intrakranial cerrahinin sonunda urapidil uygulamasının infüzyonu hem de bolus+infüzyonu, ekstübasyona bağlı hemodinamik reaksiyonları etkili bir şekilde önlemekte ve kalp hızını etkilemeden kan basıncını kontrol etmektedir. Ayrıca, gruplar arasında ekstübasyon kalitesi ve ekstübasyon süresi de benzer bulunmuştur.

Keywords

• urapidil
• remifentanil
• hemodynamics
• intracranial surgery

References

1. 1.Gesztesi Z, Mootz BL, White PF. The Use of a Remifentanil Infusion for Hemodynamic Control During Intracranial Surgery. Anesth Analg. 1999;89:1282-7. https://doi.org/10.1213/00000539-199911000-00038
2. 2.Warner DS, Hindman BJ, Todd MM et al. Intracranial pressure and hemodynamic effects of remifentanil versus alfentanil in patients undergoing supratentorial craniectomy. Anesth Analg. 1996;83:348-53. https://doi.org/10.1213/00000539-199608000-00025
3. 3.Luthra A, Prabhakar H, Rath GP. Alleviating stress response to tracheal extubation in neurosurgical patients: a comparative study of two infusion doses of dexmedetomidine. J Neurosci Rural Pract. 2017;8:49-56. https://doi.org/10.4103/jnrp.jnrp_91_17
4. 4.Zhou Y, Liu L, Fan F et al. Relation between elevated first SBP from baseline (delta SBP) and postoperative outcome. J Hypertens. 2021;39:1982-90. https://doi.org/10.1097/HJH.0000000000002872
5. 5. Louizos AA, Hadzilia SJ, Davilis DI et al. Administration of esmolol in microlaryngeal surgery for blunting the hemodynamic response during laryngoscopy and tracheal intubation in cigarette smokers. Ann Otol Rhinol Laryngol. 2007;116:107-11. https://doi.org/10.1177/000348940711600205
6. 6.Min JH, Chai HS, Kim YH et al. Attenuation of hemodynamic responses to laryngoscopy and tracheal intubation during rapid sequence induction: remifentanil vs. lidocaine with esmolol. Minerva Anestesiol. 2010;76:188-92.
7. 7.Ghodraty MR, Hasani V, Bagheri-Aghdam A et al. Remifentanil infusion during emergence moderates hemodynamic and cough responses to the tracheal tube: A randomized controlled trial. J Clin Anesth. 2016;33:514-20. https://doi.org/10.1016/j.jclinane.2015.09.001
8. 8.Kim MH, Lee KY, Bae SJ et al. Intraoperative dexmedetomidine attenuates stress responses in patients undergoing major spine surgery. Minerva Anestesiol. 2018;85:468-77. https://doi.org/10.23736/S0375-9393.18.12992-0

9. 9.Egan TD. Pharmacokinetics and pharmacodynamics of remifentanil: an update in the year 2000. Curr Opin Anaesthesiol. 13:449-455, 2000 https://doi.org/10.1097/00001503-200008000-00009
10. 10.Liu YH, Hu XB, Yang XM et al. Comparing remifentanil and sufentanil in stress reduction during neurosurgery: a randomised controlled trial. Int J Clin Pharm. 2020;42:1326-34. https://doi.org/10.1007/s11096-020-01094-1
11. 11.Guy J, Hindman BJ, Baker KZ et al. Comparison of remifentanil and fentanyl in patients undergoing craniotomy for supratentorial space-occupying lesions. Anesthesiology. 1997;86:514-24. https://doi.org/10.1097/00000542-199703000-00002
12. 12.Balakrishnan G, Raudzens P, Samra SK et al. A Comparison of Remifentanil and Fentanyl in Patients Undergoing Surgery for Intracranial Mass Lesions. Anest Analg. 2000;91:163-9. https://doi.org/10.1213/00000539-200007000-00030
13. 13.Nho JS, Lee SY, Kang JM et al. Effects of maintaining a remifentanil infusion on the recovery profiles during emergence from anaesthesia and tracheal extubation. Br J Anaesth. 2009;103:817-21. https://doi.org/10.1093/bja/aep307
14. 14.Aouad MT, Al-Alami AA, Nasr VG et al. The effect of low-dose remifentanil on responses to the endotracheal tube during emergence from general anesthesia Anesth Analg. 2009;108:1157-60. https://doi.org/10.1213/ane.0b013e31819b03d8
15. 15.Xing Y, Lin N, Han R et al. Sevoflurane versus Propofol combined with Remifentanil anesthesia Impact on postoperative Neurologic function in supratentorial Gliomas (SPRING): protocol for a randomized controlled trial. BMC Anesthesiol. 2020;20:117. https://doi.org/10.1186/s12871-020-01035-5
16. 16.Cote DJ, Burke WT, Castlen JP et al. Safety of remifentanil in transsphenoidal surgery: A single-center analysis of 540 patients. J Clin Neurosci. 2017;38:96-9. https://doi.org/10.1016/j.jocn.2016.12.011
17. 17.Coles JP, Leary TS, Monteiro JN et al. Propofol Anesthesia for Craniotomy. A Double-Blind Comparison of Remifentanil, Alfentanil, and Fentanyl. J Neurosurg Anesthesiol. 2000;12:15-20. https://doi.org/10.1097/00008506-200001000-00004
18. 18.Gunduz M, Gunes Y, Ozbek H et al. Comparison of dexmedetomidine or remifentanil infusion combined with sevoflurane anesthesia in craniotomy: hemodynamic variables and recovery. Neurosurgery Quarterly. 2009;19:116-9. https://doi.org/10.1097/WNQ.0b013e3181a45b0d
19. 19.Langtry HD, Mammen GJ, Sorkin EM. Urapidil. Drugs. 1989;38:900-40. https://doi.org/10.2165/00003495-198938060-00005
20. 20.Alijotas-Reıg J, Bove-Farre I, de Cabo-Frances F et al. Effectiveness and Safety of Prehospital Urapidil for Hypertensive Emergencies. Am J Emerg Med. 2001;19:130-3. https://doi.org/10.1053/ajem.2001.20008
21. 21.Van Aken H, Puchstein C, Anger C et al. The influence of urapidil, a new antihypertensive agent, on cerebral perfusion pressure in dogs with and without intracranial hypertension. Intensive Care Med. 1983;9:123-6. https://doi.org/10.1007/BF01772578
22. 22.Scafuro M, Cafaggi G, Petrella F et al. Urapidil: hypotension induced in neuroanesthesia. Minerva Anestesiol. 1992;58:141-4.
23. 23.Steib A, Freys G, Curzola U et al. Effects of urapidil on the cardiovascular response to intratracheal intubation. Annales Francaises D'anesthesie et de Reanimation. 1991;10:113-6. https://doi.org/10.1016/S0750-7658(05)80451-4
24. 24.Quéré J, Ozier Y, Bringier J et al. Does urapidil attenuate the blood pressure response to tracheal intubation for general anaesthesia? Drugs (Basel). 1990;40:80-1. https://doi.org/10.2165/00003495-199000404-00025
25. 25.Hernández-Palazón J, Tortosa Serrano JA, García-Palenciano C et al. Cardiovascular response to tracheal intubation in patients with intracranial tumor. Comparative study between urapidil and lidocaine. Rev Esp Anestesiol Reanim. 2000;47:146-50.
26. 26.Ye T, Luo A, Ren H et al. Preliminary report on cardiovascular responses to urapidil during intubation and extubation. Chin Med Sci J. 1993;8:240-2.
27. 27.Tauzin-Fin P, Sesay M, Gosse P et al. Effects of perioperative alpha1 block on haemodynamic control during laparoscopic surgery for phaeochromocytoma. Br J Anesth. 2004;92:512-7. https://doi.org/10.1093/bja/aeh083