Dexmedetomidine infusion for prevention of hypertension and agitation during awakening after transsphenoidal resection of pituitary adenoma

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OBJECTIVE

To analyze efficacy and safety of dexmedetomidine infusion for hemodynamic stabilization and prevention of arterial hypertension and excitation of patients upon awakening after transsphenoidal neurosurgical interventions.

MATERIAL AND METHODS

A prospective study included 40 adults with pituitary adenoma and baseline arterial hypertension. In the main group, dexmedetomidine was prescribed at a dose of 0.5 μg/kg/hour, in the control group — placebo in an equivalent volume of 0.9% saline solution. Hemodynamic analysis implied invasive blood pressure measurements during key surgical stages and postoperative awakening, as well as level of stress hormones (prolactin and cortisol).

RESULTS

Dexmedetomidine significantly reduces the incidence of arterial hypertension and tachycardia upon awakening of patients after transsphenoidal neurosurgical interventions. Moreover, this drug also reduces serum prolactin during surgery. In addition, patients in the main group had more comfortable awakening without severe agitation.

CONCLUSION

The positive effects of dexmedetomidine should be used more widely in routine clinical practice to optimize anesthetic management of transsphenoidal procedures. At the same time, this pharmacological approach requires further analysis regarding influence on the incidence of severe postoperative complications and postoperative outcomes.

Keywords:

dexmedetomidine

transsphenoidal surgery

postoperative awakening

arterial hypertension

neuroendocrine stress

hemodynamic stability

Authors:

Arefiev A.M.

Burdenko Neurosurgery Center

ORCID: 0000-0001-5864-3795

Kulikov A.S.

Burdenko Neurosurgical Center

Kurnosov A.B.

Burdenko Neurosurgery Center

ORCID: 0000-0002-9943-6829

Gadzhieva O.A.

Burdenko Neurosurgery Center

ORCID: 0000-0002-9850-050X

Lubnin A.Yu.

Burdenko Neurosurgical Center

RSCI AuthorID: 370609
Scopus AuthorID: 57192157123
ORCID: 0000-0003-2595-5877

Received:

16.05.2020

Accepted:

26.06.2020

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