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Comparison of Dexmedetomidine, Remifentanil, and Esmolol for the Control of Hypertension During Tracheal Extubation and Emergence From Anesthesia After a Craniotomy

Hypertension has been reported during emergence from anesthesia to be >90% in neurosurgical patients. We examined the effects of dexmedetomidine, remifentanil, and esmolol infusion on recovery profiles and cardiovascular responses of patients during the emergency period after a craniotomy. ASA I to III physical status patients, who were undergoing intracranial surgery for either vascular or space-occupying lesions, were eligible if aged between 17 and 65 years. Anesthesia was induced using propofol and dexmedetomidine and maintained using sevoflurane and dexmedetomidine infusion. Patients were randomly allocated in 3 groups. Dexmedetomidine infusion was continued until the initiation of skin closure in group D. Dexmedetomidine infusion was discontinued in other groups after placing the bone graft. Thereafter, remifentanil infusion (0.25 µg/kg/min) or esmolol infusion (0.25 mg/kg/min) were started in the other groups (group R or E) until the initiation of skin closure. Extubation time, recovery time, incidence of coughing during extubation, and hemodynamic variables during the emergence phase were recorded. During the emergence phase, the systolic and mean arterial blood pressures and heart rates were similar compared with baseline values in all study groups. The median extubation time was similar in the dexmedetomidine (4.9 min), remifentanil (3.9 min), and esmolol groups (2.7 min). The incidence of cough was similar in the dexmedetomidine group compared with the remifentanil or esmolol groups. Time to eye opening, time to orientation, and response to verbal command were longer in the dexmedetomidine group compared with the remifentanil group. We concluded that remifentanil, dexmedetomidine, and esmolol infusion can be used to control blood pressure during emergence from anesthesia after a craniotomy.