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Korean Journal of Anesthesiology 2006;51(2):179-184.
DOI: https://doi.org/10.4097/kjae.2006.51.2.179   
The Hemodynamic Effects of Levobupivacaine Infiltration at the Skull-pin Insertion Site and the Incision Site in Craniotomy.
Dong Jin Shin, Hong Beom Bae, Jeong Il Choi, Myung Ha Yoon
Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea. mhyoon@chonnam.ac.kr
Abstract
BACKGROUND
Several drugs have been used to reduce the hemodynamic responses evoked by skull-pin head-holder application and skin incision in neurosurgery. This study evaluated the effects of levobupivacaine infiltration on hemodynamics followed by the skull-pin head-holder application and the skin incision.
METHODS
Eighty-eight patients who had been scheduled for neurosurgery under general anesthesia were randomly divided into five groups. Saline or different concentrations of levobupivacaine (1, 2.5, 5, 7.5 mg/ml) were infiltrated into skull-pin head-holder insertion sites and the skin incision sites. Systolic (SBP) and diastolic blood pressure (DBP) and heart rate were measured just before skull-pin head-holder application and 30 sec, 1 min, 3 min and 5 min after skull-pin head-holder application and skin incision. Changes in hemodynamics were compared.
RESULTS
SBP, DBP and heart rate significantly increased after skull-pin head-holder application. The range of increase was diminished by local application of levobupivacaine. However, 5 mg/ml and 7.5 mg/ml levobupivacaine group decreased blood pressure or heart rate to below the baseline after skin incision.
CONCLUSIONS
These results indicate that 7.5 mg/ml levobupivacaine attenuates the hemodynamic responses evoked by skull-pin head-holder application, but decreases blood pressure and heart rate after skin incision in craniotomy. Therefore, 5 mg/ml levobupivacaine was effective minimum local concentration to attenuate the change of hemodynamics by skull-pin head-holder application and skin incision in craniotomy if the level of anesthesia is maintained properly.
Key Words: hemodynamics; levobupivacaine; skull-pin head-holder


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