Craniotomy presents true anesthetic challenges, mainly due to the need to optimize cerebral perfusion, facilitate brain relaxation, achieve rapid emergence for neurologic assessment, and minimize perioperative complications.
Total intravenous anesthesia, particularly with propofol-based regimens, has gained favor in neurosurgical procedures for its neuroprotective properties, and reduced intracranial pressure; however, the choice of adjunct agents in total intravenous anesthesia remains a subject of ongoing investigation, especially regarding their influence on hemodynamic stability, analgesia, brain relaxation, and postoperative outcomes. Total intravenous anesthesia techniques for craniotomy allow rapid recovery and stable hemodynamic parameters, so they decrease the hospital stay. The current study will compare the efficacy and safety profiles of dexmedetomidine, fentanyl, and magnesium sulfate as adjuncts in total intravenous anesthesia for patients undergoing craniotomy.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
120
Dexmedetomidine as an adjunct to total intravenous anesthesia.
Fentanyl as an adjunct to total intravenous anesthesia.
Magnesium sulphate as an adjunct to total intravenous anesthesia.
Zagazig university hospital
Zagazig, Egypt
The total intraoperative propofol consumption
The total intraoperative propofol consumption (in milligrams).
Time frame: 4 hours
Intraoperative heart rate
Monitoring the changes in heart rate intraoperative.
Time frame: 4 hours
Intraoperative mean arterial pressure
Monitoring the changes in mean arterial pressure intraoperative.
Time frame: 4 hours
Brain relaxation score
Evaluating the brain relaxation right after the dura is opened using a scale from 1 to 4 (1 = perfectly relaxed, 2 = satisfactorily relaxed, 3 = firm brain, 4 = bulging brain).
Time frame: 4 hours
Additional doses of intraoperative fentanyl.
The total number of patients requiring additional dose of intraoperative fentanyl.
Time frame: 4 hours
The time to first request for rescue analgesia
The time to first request for rescue analgesia in first 24 hour.
Time frame: The first 24 hours postoperative.
Postoperative pain assessment
Postoperative pain assessment by the numeric rating scale in the recovery room and at 2,4,8,16 and 24 hours after surgery.
Time frame: The first 24 hours postoperative.
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