الفهرس 
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Abstract
emergence hypertension is a major problem in craniotomy operations which may predispose to formation of intracranial hematoma. Pain during surgical closure lead to initiation of The reflex neuroendocrine response is considered as autocrines (Autonomic response catecholamines, insulin and glucagon), endocrines( cortisol, thyroxine, and AVP, growth Hormone) and paracrines(cytokine)as evident by the elevation of the level of these hormones.This will start an episode of hypertension that continues several hours postoperative. Although various drugs have been widely evaluated including various antihypertensive drugs like Labetalol, esmolol, nicardipine, and clevidipine there is limited data with regards to use of analgesia including fentanyl to the onset prevent the onset of emergence hypertension. Fentanyl is phenylpiperdine derivative synthetic opioid agonist with rapid onset, relatively short duration and widely available. Fentanyl has a wide range of doses with small doses it achieves analgesia with short duration of action.
In the present study we aimed to assess the effect of fentanyl injected at dural closure in prevention and controlling emergence hypertension. 40 normotensive adult patients operated for supratentorial tumors under standard isoflurane anesthesia. At the time of dural closure, the patients were randomly, double blinded assigned to one of two groups (n = 20 each): saline (control), fentanyl (1μg/kg). systolic arterial blood pressure (SAP), diastolic arterial blood pressure (DAP), mean arterial blood pressure (MAP) heart rate (HR) and central venous pressure which were monitored as base line value, after induction, after induction, every 15 minute, at time of dural closure, every 5 minutes till end of surgery, every 15 minute first four hours postoperative and VAS in first two hours. In control group the heart rate, systolic, diastolic and mean arterial pressure All increased significantly during emergence and first four hours post-operative. On the other hand less hemodynamic changes and fewer patients required use nitroglycerine in the fentanyl group with no difference between the two groups regarding time to emergence and postoperative pain VAS in first two hours. from the present study we concluded that Pain during surgical closure is an important cause of stress response and sympathetic stimulation leading to emergence hypertension. The use of low-doses of fentanyl during craniotomy closure is an effective technique for preventing onset of stress response subsequently preventing early postoperative hypertension and has no effect on time to emergence.