Anesthesia optimization strategy for craniotomy in patients with acute traumatic brain injury: dexmedetomidine-scalp nerve block combined with general anesthesia
10.3760/cma.j.cn131073-20241024-00306
- VernacularTitle:急性TBI患者开颅术麻醉优化策略：右美托咪定-SNB联合全麻
- Author:
Ying ZHAO
1
;
Shuquan FENG
1
;
Dailing ZHANG
1
;
Ling YU
1
;
Zhiwen YANG
1
;
Peichun LU
1
;
Jianping FEI
1
;
Shigang QIAO
1
Author Information
1. 昆山市中医医院麻醉科，昆山 215300
- Publication Type:Journal Article
- Keywords:
Brain injuries, traumatic;
Dexmedetomidine;
Scalp;
Nerve block;
Anesthesia, general
- From:
Chinese Journal of Anesthesiology
2025;45(3):291-295
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the efficacy of dexmedetomidine-scalp nerve block (SNB) combined with general anesthesia in the patients with acute traumatic brain injury (TBI) undergoing craniotomy.Methods:In this randomized controlled trial, 74 American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ patients of either sex with acute TBI, aged 30-78 yr, with body mass index of 18-30 kg/m 2, underwent craniotomy for hematoma evacuation combined with decompressive craniectomy at the Traditional Chinese Medicine Hospital of Kunshan from January to December 2024, of the Glasgow Coma Scale score 8-12, were selected and divided into 2 groups ( n=37 each) using a random number table method: dexmedetomidine combined with ultrasound-guided SNB group (DS group) and ultrasound-guided SNB group (S group). Before anesthesia, dexmedetomidine was infused as a loading dose of 1 μg/kg over 10 min followed by an infusion of 0.3 μg·kg -1·h -1 until the end of operation. Ultrasound-guided SNB was performed after completion of intubation in both groups. The consumption of intraoperative fentanyl, propofol and remifentanil and the usage of vasoactive drugs were recorded. Before surgery (T 0), at 1 h after the start of surgery (T 1) and at the end of surgery (T 2), blood samples from the jugular bulbar and radial artery were collected, the jugular venous oxygen saturation was recorded, the arteriovenous oxygen content and cerebral oxygen uptake rate were calculated, and the occurrence of postoperative complications was also recorded. Results:Compared with group S, the consumption of fentanyl, propofol and remifentanil was significantly reduced, the usage rate of vasoactive drugs was decreased, the arteriovenous oxygen content and cerebral oxygen uptake rate were decreased at T 1 and T 2, the jugular venous oxygen saturation was increased, and the incidence of postoperative agitation was decreased in group DS ( P<0.05). Conclusions:Dexmedetomidine-SNB combined with general anesthesia can optimize the analgesic effect, improve cerebral oxygen supply and demand, reduce the occurrence of postoperative agitation when used in patients with acute TBI undergoing craniotomy.
