Dexmedetomidine for awake craniotomy without laryngeal mask

Abstract

-O b j e c t i v e :This paper re p o rts the use of dexmedetomidine in three epileptic patients with cave rnous angiomas that underwent awake surg e ry in order to map their speech are a s . Method: L o a d i n g dose of dexmedetomidine varied from 1 µg/Kg/h to 3 µg/Kg/h over 20 minutes and maintenance dose fro m 0.4 µg/Kg/h to 0,8 µg/Kg/h. Results: There was no occurrence of hemodynamic instability, convulsions or re s p i r a t o ry depression. Patients tolerated well the pro c e d u re . Conclusion: Dexmedetomidine was useful f o r awake craniotomy as it decreased patients' level of consciousness but did not produce agitation. Lary n g e a l mask was not necessary to keep air ventilation.KEY WORDS: awake craniotomy, dexmedetomidine, epilepsy surgery, cortical mapping, neuroanesthesia.Dexmedetomidina em craniotomias com o paciente acordado sem o emprego de máscara laríngea RESUMO -O b j e t i v o :Este trabalho relata o uso de desmedetomidina em três pacientes com angiomas cavernosos próximos a área de linguagem e epilepsia que foram operados acordados para mapeamento cortical. Método: A dose de ataque de dexmedetomidina variou de 1 µg/Kg/h a 3 µg/Kg/h durante 20 minutos e dose de manutenção de 0,4 µg/Kg/h a 0,8 µg / K g / h . Resultados: Os pacientes toleraram bem o pro c e d imento e não houve instabilidade hemodinâmica, convulsões ou depressão re s p i r a t ó r i a . Conclusão: D e x m edetomidina foi útil nas craniotomias com o paciente acordado para mapeamento cortical pois gerou sedação sem agitação. A máscara laríngea não foi necessária para manter a ventilação nesses pacientes.PA L AV R A S -C H AVE: craniotomia, dexmedetomidina, ciru rgia para epilepsia, mapeamento cortical e neuro anestesia.Awake craniotomy is a useful technique when lesions near eloquent areas have to be re m o v e d 1 . U n f o rt u n a t e l y, pro c e d u re 's demands on patients a n d s u rgical team must not be neglected. Patients need to be fully alert and cooperative during testing b u t on the other hand, it is desirable to keep them sedated over the rest of surg e ry avoiding unnecess a ry discomfort and anxiety. It is a delicate balance, even on experienced hands, as re s p i r a t o rydep ression also has to be taken in account. To accomplish adequate level of sedation and analgesia both local and systemic anesthetics are used. A combination of opioids and midazolan associated, or n o t , to propofol or droperidol is effective. But, despite s a t i s f a c t o rylevel of stress for patients, small pro blems like agitation, drowsiness, seizure or pain still occur in 48% of the surgeries 2 . Dexmedetomidine hydrochloride is a selective alpha-2 adrenoceptor agonist with centrally mediated sympatholytic and sedative effects. It is indicated for sedation of intubated and mechanically ventilated patients during treatment in intensive c a reunits. Dexmedetomidine decreases the needs of analgesia and produces a kind of sedation that patient can be easily roused by verbal stimuli 3 . These characteristics brought about...

Efficacy of dexmedetomidine on postoperative shivering: a meta-analysis of clinical trials

“…Somnolence, one of the most dangerous complications, although rare, has been reported resulting from an overdose of dexmedetomidine. 51 Moreover, the price of dexmedetomidine is considerably higher than other drugs. Consequently, we do not recommend the use of dexmedetomidine solely for the purpose of preventing postoperative shivering.…”

Cortical stimulation of language fields under local anesthesia: optimizing removal of brain lesions adjacent to speech areas

“…For a satisfactory procedure we ideally require an awake, cooperative patient capable of undergoing neurocognitive tests [13][14][15] . different anesthetic combinations, including neurolept, propofol with or without opioid infusions, and asleep-awake-asleep techniques, have been reported for awake craniotomy.…”

Neuroradiology, Anesthesia, Bioengineering, and Hardware Programming in the Clinical Applications of Deep Brain Stimulation

“…Advantages include its ability to minimize respiratory depression while still affecting various critical brain functions, including arousal, sleep, and anxiety. Several case studies have shown very successful results with use of dexmedetomidine alone or in conjunction with propofol [67][68][69][70][71]. Other benefits of dexmedetomidine include decreased cerebral blood flow through direct -mediated smooth muscle constriction and indirectly through intrinsic neural pathways.…”