Dexmedetomidine and Neurocognitive Testing in Awake Craniotomy

Abstract

Patients are selected for awake craniotomy when the planned procedure involves eloquent areas of the brain, necessitating an awake, cooperative patient capable of undergoing neurocognitive testing. Different anesthetic combinations, including neurolept, propofol with or without opioid infusions, and asleep-awake-asleep techniques, have been reported for awake craniotomy. In all these techniques, respiratory depression has been reported as a complication. In this case series dexmedetomidine, the highly selective alpha-2 adrenoreceptor agonist, was selected for its lack of respiratory depression as well as its sedative and analgesic properties. The charts of 10 consecutive patients who underwent awake craniotomy with dexmedetomidine infusion were reviewed. Five of the patients underwent "asleep-awake" technique with a laryngeal mask airway and volatile agent. Five patients received moderate to conscious sedation. All patients received a dexmedetomidine load of 0.5 to 1.0 microg/kg over 20 minutes followed by an infusion at rates of 0.01 to 1.0 microg/kg per hour. Four patients had extensive sensory and motor testing, and six underwent neurocognitive testing, including naming, reading, counting, and verbal fluency. There were no permanent neurologic deficits, except one patient who had an exacerbation of preoperative language difficulties. Dexmedetomidine appears to be a useful sedative for awake craniotomy when sophisticated neurologic testing is required.

Dexmedetomidine in Current Anaesthesia Practice- A Review

“…It produces dose-dependent sedation, anxiolysis and analgesia (involving spinal and supraspinal sites) without respiratory depression [1,2]. Dexmedetomidine enhances anaesthesia produced by other anaesthetic drugs, causes perioperative sympatholysis and decreases blood pressure by stimulating central α2 and imidazoline receptors [3,4]. It is the dextrorotatory S-enatiomer of medetomidine and is chemically described as (+)-4-(2, 3-dimethyle phenyl) ethyl-1 H-imidazole monohydrochloride with molecular weight as 236.7.The empirical formula is C 13 H 16 HCl.…”

Uso da abordagem lateral para introdução de máscara laríngea durante craniotomia em paciente acordado: relato de caso

“…Vol Excluding hypercapnia, pain, and hyperthermia, the episode of tachycardia was attributed to a probable rebound effect due to the irregular use of the beta-adrenergic blocker. It is known that dexmedetomidine associated with regional anesthesia causes sedation, analgesia, and hemodynamic stability without respiratory depression, allowing the neurological evaluation in awake craniotomy [8][9][10][11] and carotid endarterectomy 12 . However, the effects of dexmedetomidine on brain blood flow in these two populations are still to be determined.…”

Comparison Of The Effects Of Propofol and Dexmedetomidine Sedation On Axillary Block

“…Sedatif-hipnotik ve sempatolitik özellikleri olan alfa 2 (α 2 ) adrenerjik reseptör agonisti deksmedetomidin analjezik özelliğe de sahip bir ajandır [10][11][12][13][14][15] . Diğer sedatif ajanlara göre hasta kooperasyonunun daha fazla olduğu ve derin sedasyon dozlarında bile solunum depresyonu yapmadığı bildirilmiştir [16][17][18][19][20][21] . Bu çalışmada; el ve ön kol cerrahisi yapılacak hastalarda uygulanacak intravenöz deksmedetomidin sedasyonunun, aksiller blok üzerine etkisini intravenöz propofol sedasyonu ile karşılaştırmayı amaçladık.…”