Comparison of the effect of‎‏ ‏Labetalol and Remifentanil and Dexmedetomidine in control of ‎bleeding during Craniotomy

Comparison of the effect of‎‏ ‏Labetalol and Remifentanil and Dexmedetomidine in control of ‎bleeding during Craniotomy

The study will be double blind and clinical trial.90 patients will be randomly divide into 3 groups. The groups are parallel. The trial phase is 3.

Patients with Craniotomy in Valiasr hospital in Arak are divided into 3 groups by simple randomization with envelopes. The study is double-blind in which outcome evaluator and data analyst and participant are kept blind.

Inclusion criteria: Age 18 to 75 years, ASA Class One and Two,no coagulation disorders, no history of cardiovascular disease, not addicted to opioids, body mass index more than 35, candidate patients for craniotomy Exclusion criteria: dissatisfaction with surgery, platelet count less than 150 thousand

Intervention group 1: A bolus dose of 10 millilitre of normal saline is administered for 10 minutes and then remifentanil is infused at a dose of 0.1 micro gram per kilogram per minute until the end of surgery (GlaxoSmithKline Company (London - England). Intervention group: 2: 1 micro gram in kilogram Dexmedetomidine will be infused for 10 minutes as the initial dose followed by 0.4 to 0.8 micro gram in kilogram in hours to maintain the infusion dose. (Dexmedetomidine used by Elixir Company - Iran) Intervention group 3: 0.25 milligram in kilogram ‏Labetalol intravenously as the initial dose is slow and infused within 10 minutes, followed by 1-2 milligram in kilogram intravenously to maintain the infusion dose. (Kern Pharma SL - Spain)

Surgeon satisfaction, bleeding, mean hemoglobin

Patients will be allocated into 3 groups using a permuted balanced block randomization method with the size of blocks 3 and 6. Random sequence will be generated by an epidemiologist by running an online program in sealed envelope website (https://www.sealedenvelope.com/). Random chain concealment is done by opaque envelope method.

In terms of patient blindness, the intern is responsible for completing information does not know the groupings, and general anesthesia and drug injections are performed by an anesthesiologist. Outcome assessor and data analyzer and participant are blind (double blind). Outcome assessor and data analyzer and participant don't aware from grouping. The intern is unaware of the drugs prescribed in each group and the anesthesiologist prepares the drugs and provides them to the intern. Also, the patients do not know about their group.