Control of emergence hypertension after craniotomy for brain tumor surgery

OBJECTIVE: To compare the anti-hypertensive effects of both remifentanil and esmolol infusion.

METHODS: This prospective comparative study was conducted on 20 patients (10 patients in each group), in the Neurosurgical Theater of Kasr Elaini Hospital, Cairo, Egypt from 2006 to 2008. The patients were divided into 2 equal groups. In group one, remifentanil was used as a bolus of one ug/kg intravenous (iv) in 30-60 seconds, followed by infusion at a rate of 0.25-0.5 ug/kg/min until the systolic blood pressure was <140 mm Hg. In group 2, esmolol was given as a 500 ug/kg iv bolus in 30 seconds followed by continued infusion of 100-300 ug/kg/min until systolic blood pressure was <140 mm Hg. Infusion was continued until the patients left the post anesthesia care unit (PACU).

RESULTS: The onset time of decreasing blood pressure was shorter in group 2 (40+/-0.01 seconds) than group one (52.5+/-4.47 seconds). The PACU and hospital stay were comparable between both groups.

CONCLUSION: Remifentanil can be used to control blood pressure during emergence of anesthesia after craniotomy for brain tumors. It has higher rapid recovery score than esmolol and other narcotics. In addition, it can be used when esmolol is contraindicated such as in cardiac patients, asthmatics, chronic obstructive pulmonary disease, or during pregnancy. Also, it decreases the need for postoperative analgesia and allows sedation if the infusion is continued as surgical patients are admitted to the ICU.