Comparison of the effects of dexmedetomidine and remifentanil in sedation, analgesia, and vital signs in patients undergoing stereotactic brain biopsy: a single-blind control trial

Abstract

Background: stereotactic frame-based brain biopsy is a minimally invasive neurosurgical procedure. Dexmedetomidine, an alpha-2 adrenergic agonist decreases heart rate, blood pressure, and stress response. Remifentanil is a short-acting opioid receptor agonist. In this study, we aim to compare the effects of dexmedetomidine and remifentanil on sedation, hemodynamic alterations, analgesia, and recovery profile of patients who underwent stereotactic brain biopsy. Method: a single-blind clinical trial was conducted. Forty patients with American society of anesthesiology(ASA) class II were included. Initially, local anesthesia was administered and stereotactic frames were installed, then patients were transferred for magnetic resonance imaging (MRI) evaluations. Afterward, patients were randomly divided into two groups: The R group which received remifentanil, and the D group which received dexmedetomidine. Blood pressure, oxygen saturation, heart rate, and Ramsay sedation scale (RSS) of all included cases were recorded throughout the operation. After transferring to the post-anesthesia care unit (PACU), the visual analog score (VAS) and the amount of consumed morphine by each patient were measured. The statistical analysis was conducted using SPSS version 22. Descriptive analysis, analysis of variance (ANOVA), and independent t-test were performed. A P-value less than 0.05 was considered to be statistically significant. Results: forty consecutive patients consisting of 22 males and 18 females were included. Patients were randomly divided into two equal groups. After conducting statistical analysis, it was revealed that RSS was higher in the R group. Indicating a higher level of sedation. Heart rate, systolic blood pressure, and diastolic blood pressure were all higher in the D group. Furthermore, the VAS and consumed morphine were lower in the D group. Conclusion: The RSS was higher in the R group, indicating a higher level of sedation in patients who received remifentanil. All recorded vital signs were higher in the D group. implicating that the vital signs were more stable during the operation in patients who received dexmedetomidine. In addition, the VAS and dose of consumed morphine in PACU were lower in the D group. Trial registration: the current study was registered in The Iranian registry clinical trial (code =IRCT20210415050983N2).