Effect of remifentanil or ropivacaine on hemodynamic response to skull ⁃ pin insertion for craniotomy

Abstract

Objective To compare the effect of remifentanil bolus infusion or ropivacaine local infiltration on hemodynamic change during skull ⁃ pin insertion for craniotomy under general anesthesia. Methods Forty patients scheduled for craniotomy were randomly divided into 2 groups to receive remifentanil 1 μg/kg intravenously (group R) or local infiltration with 1% ropivacaine (group L) at pin site. Mean arterial pressure (MAP) and heart rate (HR) were recorded before induction or local infiltration just after skull⁃pin insertion, and 1, 3, 5 and 10 min after skull⁃pin insertion. Results The HR recorded at the time points after skull⁃pin insertion in group R was decreased significantly than that of group L (1 min after skull⁃pin insertion: t = ⁃ 2.027, P = 0.050; 3 min after skull⁃pin insertion: t = ⁃ 3.244, P = 0.002; 5 min after skull ⁃ pin insertion: t = ⁃ 6.850, P = 0.012; 10 min after skull ⁃ pin insertion: t = ⁃ 2.774, P = 0.009; respectively). The MAP recorded at the time points after skull ⁃ pin insertion did not differ significantly between the 2 groups (P = 0.134). The MAP recorded at 5 and 10 min after skull ⁃ pin insertion was significantly decreased than that before local infiltration (t = 5.200, P = 0.007; t = 7.400, P = 0.000; respectively) in group R. In group L, the MAP began to decrease significantly at 10 min after skull⁃pin insertion (t = 5.600, P = 0.002). Conclusion Both 1 μg/kg remifentanil intravenously and local infiltration with ropivacaine can prevent hemodynamic fluctuation during skull⁃pin insertion for craniotomy, while the former is easy to operate. DOI：10.3969/j.issn.1672-6731.2010.05.011

Keywords

• Fentanyl
• Anesthesia, intravenous
• Anesthesia, local
• Neurosurgical procedures
• Pain