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Anaesthesia Critical Care & Pain Medicine
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le lundi 19 novembre 2018
Doi : 10.1016/j.accpm.2018.10.016
Haemodynamic changes and incisional bleeding after scalp infiltration of dexmedetomidine with lidocaine in neurosurgical patients
 

Hyunzu Kim a, Seung-Ho Choi b, c, Sang-Hee Ha b, Won-Seok Chang d, Gyoung-A Heo a, Jimyeong Jeong a, Kyeong Tae Min b, c,
a Department of Anaesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, South Korea 
b Department of Anaesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea 
c Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea 
d Department of Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea 

Correspondence to: Department of Anaesthesiology and Pain Medicine, Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, 50–51, Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea.Department of Anaesthesiology and Pain MedicineAnaesthesia and Pain Research InstituteYonsei University College of Medicine50–51, Yonsei-ro, Seodaemun-guSeoul120-752South Korea
Abstract
Background

The purpose of this randomised controlled study is to compare the haemodynamic changes and the degree of incisional bleeding after scalp infiltration of lidocaine and dexmedetomidine versus lidocaine and epinephrine for patients with hemi-facial spasm undergoing microvascular decompression.

Methods

Fifty-two patients were injected with 5 mL of 1% lidocaine with either dexmedetomidine (2 μg/mL) or epinephrine (1:100,000 dilution) to reduce scalp bleeding. Mean blood pressure and heart rate were recorded every minute for 15 minutes after scalp infiltration. The primary outcome was the incidence of predefined hypotension, which was treated with administration of 4 mg ephedrine as often as needed. The number of administrations and total amount of ephedrine administered were also recorded as a measure of the severity of hypotension. The neurosurgeon scored incisional bleeding by numeric rating scale from 0 (worst) to 10 (best).

Results

The incidence of hypotension (68% vs. 34.8%, P  = 0.02) and the frequency (P  = 0.02) and total dose (P  = 0.03) of ephedrine administered were lower in the dexmedetomidine group than in the epinephrine group. In addition, there was no difference in mean blood pressure between the two groups but heart rates were lower in the dexmedetomidine group (P  = 0.01). Incisional site bleeding was better with epinephrine (median [interquartile range] of the numeric rating Score: 6 [4] in the dexmedetomidine group and 8 [2] in the epinephrine group; P  < 0.001).

Conclusion

The dexmedetomidine-lidocaine combination may be recommended as a substitute for epinephrine-lidocaine for scalp infiltration in neurosurgical patients, especially neurologically compromised patients.

The full text of this article is available in PDF format.

Keywords : Craniotomy, Dexmedetomidine, Epinephrine, Haemodynamic change, Incisional bleeding, Lidocaine




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