Combination of Continuous Dexmedetomidine Infusion with Titrated Ultra-Low-Dose Propofol-Fentanyl for an Awake Craniotomy: Case report

Das, Samaresh; Al-Mashani, Ali; Suri, Neelam; Salhotra, Neeraj; Chatterjee, Nilay

doi:10.18295/squmj.2016.16.03.014

Cited by 3 publications

(2 citation statements)

References 13 publications

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“…1,7,34 Conscious sedation with dexmedetomidine has been reported to be suitable for high-risk patients with difficult airway management, being associated with a generally low necessity for performing active rescue airway management. 12 In a recent study, dexmedetomidine demonstrated significantly fewer adverse respiratory events compared with sedation with propofol and remifentanil.…”

Section: Discussionmentioning

confidence: 99%

Conscious sedation with dexmedetomidine compared with asleep-awake-asleep craniotomies in glioma surgery: an analysis of 180 patients

Molina¹,

Schipmann²,

Mueller³

et al. 2018

Journal of Neurosurgery

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OBJECTIVEAwake craniotomies have become a feasible tool over time to treat brain tumors located in eloquent regions. Different techniques have been applied in neurooncology centers. Both “asleep-awake-asleep” (asleep) and “conscious sedation” were used subsequently at the authors’ neurosurgical department. Since 2013, the authors have only performed conscious sedation surgeries, predominantly using the α2-receptor agonist dexmedetomidine as the anesthetic drug. The aim of this study was to compare both mentioned techniques and evaluate the clinical use of dexmedetomidine in the setting of awake craniotomies for glioma surgery.METHODSThe authors retrospectively analyzed patients who underwent operations either under the asleep condition using propofol-remifentanil or under conscious sedation conditions using dexmedetomidine infusions. In the asleep group patients were intubated with a laryngeal mask and extubated for the assessment period. Adverse events, as well as applied drugs with doses and frequency of usage, were recorded.RESULTSFrom 224 awake surgeries between 2009 and 2015, 180 were performed for the resection of gliomas and included in the study. In the conscious sedation group (n = 75) significantly fewer opiates (p < 0.001) and vasoactive (p < 0.001) and antihypertensive (p < 0.001) drugs were used in comparison with the asleep group (n = 105). Furthermore, the postoperative length of stay (p < 0.001) and the surgical duration (p < 0.001) were significantly lower in the conscious sedation group.CONCLUSIONSUse of dexmedetomidine creates excellent conditions for awake surgeries. It sedates moderately and acts as an anxiolytic. Thus, after ceasing infusion it enables quick and reliable clinical neurological assessment of patients. This might lead to reducing the amount of administered antihypertensive and vasoactive drugs as well as the length of hospitalization, while likely ensuring more rapid surgery.

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Section: Discussionmentioning

confidence: 99%

Conscious sedation with dexmedetomidine compared with asleep-awake-asleep craniotomies in glioma surgery: an analysis of 180 patients

Molina¹,

Schipmann²,

Mueller³

et al. 2018

Journal of Neurosurgery

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“…In contrast, dexmedetomidine is a highly selective alpha-2 -adrenoreceptor agonist with both sedative and analgesic properties and is not associated with respiratory depressant effects. Dexmedetomidine has been studied for its sedation-and analgesia-sparing properties in intensive care and surgical settings (eg, neurosurgery, maxillofacial surgery, ENT surgery) but not in vitreoretinal surgery (7)(8)(9). Dexmedetomidine is mainly administered intravenously.…”

mentioning

confidence: 99%

Remifentanil target-controlled infusion with intranasal dexmedetomidine for vitreoretinal procedures: a randomized controlled trial

Potočnik¹,

Andjelkovič-Juvan²,

Hostnik³

et al. 2021

Croat Med J

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Aim To evaluate the consumption of remifentanil (as a primary end-point), analgesia, sedation, hemodynamics, respiratory effects, and surgeon and patient satisfaction (as a secondary end-point) with dexmedetomidine sedation compared with those of remifentanil sedation in patients undergoing vitreoretinal surgery.Methods Patients subjected to retinal ophthalmic surgical procedures were randomized to one of two intraoperative sedation groups: one group (n = 21) received intranasal dexmedetomidine plus intravenous remifentanil (DEX-REMI group), and the other group (n = 19) received intravenous remifentanil only (REM group). The treatment was placebo-controlled. The sedation level was controlled according to the bispectral index, with target values between 80%-90%. Patient levels of comfort, sedation, and pain were documented. The number of intraoperative complications and the level of satisfaction were assessed. Remifentanil consumption and hemodynamic parameters were also included in the statistical analysis. ResultsThe level of remifentanil consumption was significantly lower in the DEX-REMI group, but combination sedation improved the surgeon's, anesthesiologist's, and patients' satisfaction scores. Importantly, the number of complications was zero in the DEX-REMI group, while eight cases of complications were noted in the REM group. The DEX-REMI group showed lower mean minimal arterial pressure, but it was still in the normotensive range.Conclusions For patients undergoing ophthalmic procedures, sedation with a combination of intranasal dexmedetomidine and an intravenous infusion of remifentanil provides lower remifentanil consumption, better satisfaction scores, and a lower complication rate than sedation with a remifentanil infusion alone.

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Chirurgie des tumeurs cérébrales en condition éveillée

Arzoine¹,

Vallée

Madadaki

et al. 2019

Le Praticien en Anesthésie Réanimation

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Combination of Continuous Dexmedetomidine Infusion with Titrated Ultra-Low-Dose Propofol-Fentanyl for an Awake Craniotomy: Case report

Cited by 3 publications

References 13 publications

Conscious sedation with dexmedetomidine compared with asleep-awake-asleep craniotomies in glioma surgery: an analysis of 180 patients

Conscious sedation with dexmedetomidine compared with asleep-awake-asleep craniotomies in glioma surgery: an analysis of 180 patients

Remifentanil target-controlled infusion with intranasal dexmedetomidine for vitreoretinal procedures: a randomized controlled trial

Chirurgie des tumeurs cérébrales en condition éveillée

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