Trial Information

A Comparison of Remifentanil and Dexmedetomidine for Craniotomy Perioperative Hemodynamics and Postoperative Pain

Anesthesia for craniotomy presents a unique challenge to the anesthesiologist. Anesthesia
for neurosurgical procedures should provide optimal surgical conditions while maintaining
appropriate cerebral oxygen supply and stable systemic hemodynamics. (1) It is important
to prevent patient response to noxious stimuli during the procedure like pinning, drilling
of the bone, opening and manipulation of the dura etc., avoid coughing and bucking during
surgery and during extubation thus necessitating a deeper level of anesthesia and analgesia.
At the same time it is desirable to have the patient fully awake toward the end of the
surgery in order to facilitate neurologic evaluation. Management of the above presents a
challenge during induction, maintenance and extubation and also during multiple critical
stages of surgery Fear of the side effects of analgesic drugs frequently leads to the
under-treatment of post-craniotomy pain. (2) Nevertheless, this pain continues to be
commonly observed, is frequently severe, and, if unrelieved, may cause distress for the
neurosurgical patient and serious complications for the operative brain. (2) There is a need
for larger trials to delineate safety and efficacy of analgesic therapies with a focus on
short- and long-term outcomes.