Brain Neoplasms

Surgery

2 ml of dexmedetomidine at a concentration of 100 ug/ml is diluted by 98 ml normal saline to a concentration of 2 ug/ml. The required amount of experimental drugs is confirmed according to the weight and grouping, and diluted using normal saline to 20 ml.

dexmedetomidine

normal saline

Yue Yun

Small-dose Dexmedetomidine Effects on Recovery Profiles of Supratentorial Tumors Patients From General Anesthesia

Randomized, Parallelled and Double-blinded Trial of Small-dose Dexmedetomidine Effects on Recovery Profiles of Supratentorial Tumors Patients From General Anesthesia

Patients' SBP, DBP, MAP and HR are recorded before and every 5 minutes after drug intervention until recovery from anesthesia and removal of the tracheal intubation.
Record SBP, DBP, MAP, HR, and SpO2 values immediately after extubation. Record SBP, DBP, MAP, HR, and SpO2 values every 5 minutes after extubation. Record SBP, DBP, MAP, HR, and SpO2 values every 5 minutes after PACU entry. Record SBP, DBP, MAP, HR, and SpO2 values at 0, 60, 120 and 240 minutes after returning to the ward.

Record the patient's anesthesia time (from the anesthetic induction to termination of anesthetic infusion), operative time (from skin incision to the end of suturing), awakening time (from the end of surgery to eye opening in response to voices), spontaneous breathing recovery time (from the end of surgery to recovery of spontaneous breathing), extubation time (from the end of surgery to extubation).

Using Four-point subjective scale: 0 = no cough; 1 = mild cough; 2 = moderate cough; 3 = severe cough.

Richmond Agitation-Sedation Scale (RASS) is used for sedation assessment. Scores on RASS are recorded at tracheal extubation, every 5 minutes after extubation, and at 0, 30, 60, 120, 240 minutes after returning to the ward.
If RASS>=2 during emergence from general anesthesia, the bolus injection of propofol 1.5-2.5mg/kg can be applied when necessary.

Verbal numerical rating scale (VNRS) is employed for assessment of pain intensity (PI). The scores range from 0-10: 0 = no pain, 1-3 = mild pain, 4-6 = moderate pain, and 7-10 = severe pain.
In the operation room, the subject is asked to say the VNRS scores by the PACU nurse, and the score is recorded. The VNRS assessment is also conducted at 5, 15, 30 minutes after recovery from anesthesia, and at 0, 30, 60, 120, 240 minutes after returning to the ward.
During emergence from general anesthesia, if VNRS score> = 6 points, a single-dose bolus injection of sufentanil 5 ug is applied; if pain is not alleviated, sufentanil 5 ug can be given again after 5 minutes, and total dose does not exceed 10 ug.

When MAP> 90 mmHg during maintenance of anesthesia, the amount of anesthetic drugs will be increased, i.e. the inhalation concentration of sevoflurane, propofol and/or remifentanil infusion dose. If the result is still not satisfactory, a single dose of nicardipine 0.5-1 mg via intravenous injection will be added.
When MAP <60 mmHg, a single intravenous injection of ephedrine 5-10 mg can be given, while the value of MAP also can be adjusted by fluid replacement and reducing anesthetic doses (such as the inhalation concentration of sevoflurane, propofol, and/or remifentanil infusion dose) to adjust; if the effect is still not satisfactory, continuous infusion of 2% norepinephrine is recommended to maintain blood pressure in the target range.

When HR> 90 beats/min or ST-T segment abnormalities on ECG appear during maintenance of anesthesia, a single dose of 5-10 mg esmolol can be given intravenously, and meanwhile, the fluid replacement is recommended. When HR <45 beats/min, a single dose of 0.3-0.5 mg atropine can be given intravenously; if the result is not satisfactory and repeated administration is up to the maximum cumulative amount of 2 mg, isoproterenol 1 mg/500 ml can be given intravenously and the infusion speed can be adjusted based on HR.

If MAP> BV +20% lasts more than 1 minute during anesthesia recovery period, a single-dose bolus injection of nicardipine 0.5-1mg is given; if the result is not satisfactory, repeated doses (nicardipine 10 mg/100 ml) and the infusion rate can be adjusted according to blood pressure values.
If MAP <70 mmHg lasts more than 1 minute, a single-dose bolus injection of ephedrine 5-10 mg bolus is preferred, and meanwhile, the fluid replacement is also introduced under the premise of exclusion of cardiogenic shock; if necessary, continuous infusion of 2% norepinephrine can be given to maintain the blood pressure in the target range.

When HR> 120 beats/min or ST-T segment abnormalities on ECG appear during anesthesia recovery period, a load dose of esmolol 5-10 mg is necessary followed by continuous intravenous infusion of esmolol 100 mg/100 ml to control HR. The infusion rate is adjusted according to the value of HR.
When HR <45 beats/min, the bolus injection of atropine 0.3-0.5 mg is given; if the result is not satisfactory and repeated administration is up to the maximum cumulative amount of 2 mg, repeated administration to the maximum cumulative amount 2mg, the intravenous infusion of isoproterenol 1 mg/500 ml can be given and the infusion rate is adjusted according to the HR value.

If chills reaction appear when the patient emerges from general anesthesia, the intravenous injection of tramadol hydrochloride 0.1 g should be given slowly on the basis of heat preservation; if appearance of nausea and vomiting, the intravenous injection of tropisetron hydrochloride (Xinbei) 5 mg should be given.

Palinesthesia is evaluated by the surgeon based on a visual analogue scale VAS 0-10 points: 0=dissatisfied, 10=very satisfied.

Randomized, parallelled and double-blinded trial of small-dose dexmedetomidine effects on recovery profiles of supratentorial tumors patients from general anesthesia

China Medical University, China

administration of sevoflurane with oxygen and nitrous oxide as same ratio of 3 L/min for maintenance of general anesthesia

administration of desflurane with oxygen and nitrous oxide as same ratio of 3 L/min for maintenance of general anesthesia

administration of sevoflurane with oxygen and nitrous oxide as same ratio of 3 L/min for maintenance of general anesthesia
Sevoflurane: The investigators decrease to 1 minimal alveolar concentration(MAC) of anesthetic combination of sevoflurane and nitrous oxide, and maintain end-tidal concentration of anesthetic combination at 1 MAC until the end of surgery. At the end of surgery, sevoflurane and nitrous oxide are discontinued.

Sevoflurane

administration of desflurane with oxygen and nitrous oxide as same ratio of 3 L/min for maintenance of general anesthesia
Desflurane: The investigators decrease to 1 MAC of anesthetic combination of desflurane and nitrous oxide, and maintain end-tidal concentration of anesthetic combination at 1 MAC until the end of surgery. At the end of surgery, desflurane and nitrous oxide are discontinued.

Desflurane

Total

Sex: Female, Male

The outcomes assessor will evaluate the severity of emergence agitation of participants using a four-point categorical scale. (1: calm, 2: not calm, but could be easily calmed, 3: moderately agitated or restless, 4: combative, excited, disoriented) We considered presence of emergence agitation as 3 and 4 of four-point scale.

The Incidence of Emergence Agitation Using Four-point Categorical Scale

We will evaluate the time from gas discontinuation to extubation. We will conduct an extubation when participants can show responses such as eye opening or nodding one's head to our verbal commands.

The Time to Extubation

The outcomes assessor will evaluate the degree of postoperative pain using a numeric rating scale (NRS). (0 = no pain, 10 = unimaginable severe pain)

Postoperative Pain

The outcomes assessor will evaluate the sense of suffocation using a numeric rating scale(NRS). (0 = no sense of suffocation, 10 = unimaginably severe sense of suffocation)

Sense of Suffocation

Overall Study

Dr. Chong Wha Baek

Emergence Agitation

The investigators decrease to 1 minimal alveolar concentration(MAC) of anesthetic combination of sevoflurane and nitrous oxide, and maintain end-tidal concentration of anesthetic combination at 1 MAC until the end of surgery. At the end of surgery, sevoflurane and nitrous oxide are discontinued.

The investigators decrease to 1 MAC of anesthetic combination of desflurane and nitrous oxide, and maintain end-tidal concentration of anesthetic combination at 1 MAC until the end of surgery. At the end of surgery, desflurane and nitrous oxide are discontinued.

emergence delirium/œdème

Small-dose Dexmedetomidine Effects on Recovery Profiles of Supratentorial Tumors Patients From General Anesthesia

Comparison of Emergence Agitation Between Sevoflurane and Desflurane Anesthesia After Orthognathic Surgery

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