Dexmedetomidina para teste neurocognitivo em craniotomia com o paciente acordado: relato de caso

Santos, Marcelo Cursino Pinto dos; Vinagre, Ronaldo Contreras Oliveira

doi:10.1590/s0034-70942006000400008

Cited by 4 publications

(5 citation statements)

References 7 publications

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“…Bekker et al first reported that DEX could be used safely in patients undergoing awake craniotomy (Bekker et al, 2001). Following studies evaluated the influence of DEX on the ability to perform neurocognitive testing during neurosurgery, but the results were not consistent (Mack et al, 2004; Santos and Vinagre, 2006). Uyar et al reported that a single bolus dose of DEX before induction of anesthesia could attenuate the hemodynamic and neuroendocrine responses to skull-pin insertion (Uyar et al, 2008).…”

Section: Discussionmentioning

confidence: 99%

The Opioid-Sparing Effect of Perioperative Dexmedetomidine Plus Sufentanil Infusion during Neurosurgery: A Retrospective Study

Su¹,

Ren

Zhang

et al. 2016

Front. Pharmacol.

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Background: Approximately 60% of patients experience moderate-to-severe pain after neurosurgery, which primarily occurs in the first 24–72 h. Despite this, improved postoperative analgesia solutions after neurosurgery have not yet been devised. This retrospective study was conducted to evaluate the effect of intra- and post-operative infusions of dexmedetomidine (DEX) plus sufentanil on the quality of postoperative analgesia in patients undergoing neurosurgery.Methods: One hundred and sixty-three post-neurosurgery patients were divided into two groups: Group D (DEX infusion at 0.5 μg·kg−1 for 10 min, then adjusted to 0.3 μg·kg−1·h−1 until incision suturing) and Group ND (no DEX infusion during surgery). Patient-controlled analgesia was administered for 72 h after surgery (Group D: sufentanil 0.02 μg·kg−1·h−1 plus DEX 0.02 μg·kg−1·h−1, Group ND: sufentanil 0.02 μg·kg−1·h−1) in this retrospective study. The primary outcome measure was postoperative sufentanil consumption. Hemodynamics, requirement of narcotic, and vasoactive drugs, recovery time and the incidence of concerning adverse effects were recorded. Pain intensity [Visual Analogue Scale (VAS)], Ramsay sedation scale (RSS) and Bruggemann comfort scale (BCS) were also evaluated at 1, 4, 8, 12, 24, 48, and 72 h after surgery.Results: Postoperative sufentanil consumption was significantly lower in Group D during the first 72 h after surgery (P < 0.05). Compared with Group ND, heart rate (HR) in Group D was significantly decreased from intubation to 20 min after arriving at post anesthesia care unit (PACU), while mean arterial pressure (MAP) in Group D was significantly decreased from intubation to 5 min after arriving at PACU (P < 0.05). The intraoperative requirements for sevoflurane, remifentanil, and fentanyl were approximately 35% less in Group D compared with Group ND. VAS at rest at 1, 4, and 8 h and with cough at 12, 24, 48, and 72 h after surgery were significantly lower in Group D (P < 0.05). Compared with Group ND, patients in Group D showed lower levels of overall incidence of tachycardia, hypertension, nausea, and vomiting (P < 0.05). There were no significant differences between the two groups in terms of baseline clinical characteristics, recovery time, RSS, and BCS (P > 0.05).Conclusions: DEX (0.02 μg·kg−1·h−1) plus sufentanil (0.02 μg·kg−1·h−1) could reduce postoperative opioid consumption and concerning adverse adverse effects, while improving pain scores. However, it did not influence RSS and BCS during the first 72 h after neurosurgery.

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Section: Discussionmentioning

confidence: 99%

The Opioid-Sparing Effect of Perioperative Dexmedetomidine Plus Sufentanil Infusion during Neurosurgery: A Retrospective Study

Su¹,

Ren

Zhang

et al. 2016

Front. Pharmacol.

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“…This allows thorough pre-anesthesia assessment that yields pertinent information on the medical history of the patient and their physical and mental condition. When present, neurological deficits and the pattern of convulsive seizures must also be identified 3 . Patients exhibiting confusion, impaired communication, extreme anxiety, that require surgical positioning in ventral decubitus, as well as situations involving highly painful procedures and inability of the patient to remain still, are all exclusion criteria for the procedure [3,4].…”

Section: Pre-anesthesia Assessmentmentioning

confidence: 99%

“…When present, neurological deficits and the pattern of convulsive seizures must also be identified 3 . Patients exhibiting confusion, impaired communication, extreme anxiety, that require surgical positioning in ventral decubitus, as well as situations involving highly painful procedures and inability of the patient to remain still, are all exclusion criteria for the procedure [3,4]. Severe obesity (BMI > 40 kg/m 2 ), obstructive sleep apnea, symptomatic gastroesophageal reflux, altered mental state, dysphasia, large vascular tumors and major involvement of the dura mater are also cited in the literature as criteria for exclusion for the procedure 4 .…”

Section: Pre-anesthesia Assessmentmentioning

confidence: 99%

“…Pre-anesthesia medications are not recommended because they may blunt the senses. In order to avoid distortions on electrocorticography, drugs such as benzodiazepines must not be prescribed 3 . Anticonvulsants and antiparkinsonian drugs must be maintained up until a few hours prior to the procedure 6 .…”

Section: Pre-anesthesia Assessmentmentioning

confidence: 99%

“…All of the details of the sur-gery should be explained and the need for patient collaboration during the procedure should be emphasized. Patients should be made aware of the possibility of nausea, vomits and convulsive seizures during the intra-operative and post-operative periods, among other potential complications 3 .…”

Section: Pre-anesthesia Assessmentmentioning

confidence: 99%

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Principios de la anestesia para craneotomía en paciente vigil

2019

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La realización de una craneotomía con el paciente despierto se está utilizando cada vez más en diversas situaciones, como en neurocirugía funcional sobre la estimulación cerebral para tratar la enfermedad de Parkinson y la cirugía para tratar la epilepsia, así como los procedimientos neuroquirúrgicos destinadas a resección de tumores cerebrales en áreas elocuentes. Los principios anestésicos para realizar la craneotomía despierta tienen el objetivo de realización de una analgesia adecuada, sedación, la estabilidad hemodinámica sistémica y la permeabilidad de la vía aérea con el tipo de procedimiento neuroquirúrgico a realizar. El objetivo de este estudio es revisar los principios que rigen la conducta de la anestesia para la neurocirugía que es necesario para lograr la craneotomía con el paciente despierto.

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Clinical benefits of dexmedetomidine versus propofol in adult intensive care unit patients: a meta-analysis of randomized clinical trials

Xia

Chen

Yao

et al. 2013

Journal of Surgical Research

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Dexmedetomidina para teste neurocognitivo em craniotomia com o paciente acordado: relato de caso

Abstract: Awake craniotomy with the proper mapping of speech and motor cortical areas was successfully done with the continuous infusion of dexmedetomidine. Both the patient and the surgical team were pleased with the technique.

Cited by 4 publications

References 7 publications

The Opioid-Sparing Effect of Perioperative Dexmedetomidine Plus Sufentanil Infusion during Neurosurgery: A Retrospective Study

The Opioid-Sparing Effect of Perioperative Dexmedetomidine Plus Sufentanil Infusion during Neurosurgery: A Retrospective Study

Principios de la anestesia para craneotomía en paciente vigil

Clinical benefits of dexmedetomidine versus propofol in adult intensive care unit patients: a meta-analysis of randomized clinical trials

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