Attenuation of Haemodynamic Response to Placement of Mayfield Skull Pin Head Holder - Comparison of Dexmedetomidine versus Propofol Infusion - A Prospective Observational Study from a Tertiary Care Centre in Central Kerala


Unni1, Ranju Sebastian2, Elizabeth Joseph3, Remani Kelan Kamalakshi4, Jamsheena Muthira Parambath5

Anaesthesia for neurosurgery requires special considerations. The brain is
enclosed in a rigid cranium, so the rise in intracranial pressure (ICP) which impairs
cerebral perfusion pressure (CPP), results in irrepairable damage to various vital
areas in the brain. Stable head position is required in long neurosurgical
procedures. This is obtained with the use of clamps which fix the head rigidly. This
is done usually under general anaesthesia because it produces intense painful
stimuli leading to stimulation of sympathetic nervous system which in turn causes
release of vasoconstrictive agents. This can impair perfusion in all organ systems.
The increase in blood pressure due to sympathetic nervous system causes increase
in blood flow. This causes increases in intracranial pressure which result in
reduction in cerebral perfusion pressure once the auto regulatory limits are
exceeded. We compared the effects of dexmedetomidine 1μgm/kg and propofol
100μgm/kg given as infusion over a period of 10 minutes before the induction of
anaesthesia and continued till 5 minutes after pinning to attenuate the stress
response while cranial pinning.
Objective: To compare the effects of dexmedetomidine and propofol as infusion
to attenuate the stress response while cranial pinning in patients undergoing
neurosurgical procedures.
Group 1 receiving dexmedetomidine: group 2 receiving propofol, both drugs given
as infusion. Haemodynamic variables were monitored before and after cranial
pinning. Data was analysed using IBM SPSS Statistics. The parameters recorded
were analysed with the help of a statistician.
The two groups were comparable in demographic data. Incidence of tachycardia
between group 1 and 2 showed that tachycardia to pinning was better controlled
with propofol than dexmedetomidine (P < 0.05) which is statistically significant.
There is no statistically significant difference in blood pressure values between
group 1 and 2 after pinning.
From our study, we came to a conclusion that propofol was superior to
dexmedetomidine in attenuating the heart rate response to cranial pinning. The
effect of propofol and dexmedetomidine was comparable in attenuating the blood
pressure response to cranial pinning.