Induced Hypotensive Anaesthesia by Remifentanil and Dexmedetomidine during Supratentorial Craniotomy

Open Access

Abstract

Background: Controlled hypotensive anaesthesia is routinely applied in supratentorial craniotomy to optimize the surgical field and reduce blood loss. Dexmedetomidine and remifentanil are widely used adjuvants with distinct pharmacological profiles. Objective: To compare the effects of dexmedetomidine and remifentanil as adjuvants to propofol-isoflurane anaesthesia on intraoperative haemodynamics, anaesthetic consumption and perioperative outcomes. Methods & Materials: This quasi-experimental study included 40 ASA I-II patients undergoing elective supratentorial craniotomy, allocated into two equal groups: dexmedetomidine (Group D) and remifentanil (Group R). Haemodynamic variables, drug requirements, blood loss, surgical duration, and recovery profile were recorded and analysed using SPSS v27. A p-value <0.05 was considered significant. Results: Significant reductions in heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were observed in Group R compared to Group D during most intraoperative time points (p<0.05). MAP was consistently lower in Group R from 30 minutes to 3 hours post drug administration (p=0.001). Group R also demonstrated lower SBP and DBP during sustained intraoperative periods. Total propofol consumption was comparable between groups, although maintenance adjuvant requirements differed significantly (p=0.001). Blood loss was lower in Group R. Duration of surgery and anaesthesia were similar between groups. Recovery profiles were slightly better in Group R. Conclusion: Remifentanil-based controlled hypotensive anaesthesia provides more stable intraoperative haemodynamics and improved surgical conditions compared to dexmedetomidine in supratentorial craniotomy.