Comparison of Dexmedetomidine and Propofol for Conscious Sedation in Awake Craniotomy

Shen, Shuixian; Zheng, Jiayin; Zhang, Jun; Wang, Wenyuan; Jin, Tao; Zhu, Jing; Zhang, Qi

doi:10.1177/1060028013504082

Cited by 49 publications

(60 citation statements)

References 30 publications

(61 reference statements)

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“…In another study, similar effects were reported with Dexmedetomidine and Propofol (Ünsal et al, 2004). Findings of the study was in line with the results of (Banihashem, SalehiOmran, & Jalalian, 2015) (Shen et al, 2013), (Wang, Shi, Qin, Zhou, & Xia, 2017).…”

Section: Discussionsupporting

confidence: 81%

Comparison of the Effect of Dexmedetomidine and Propofol on Duration of Starting Tremor after Drug discontinuation in Parkinson's Patients under Deep Brain stimulation

Behnaz¹,

Ghasemi²,

Shabanpour³

2018

JMBR

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The purpose of this study was to compare the effects of Dexmedetomidine and Propofol on the duration of starting tremor after drug discontinuation in patients with Parkinson's disease under deep brain stimulation. In order to reach the research goals, 28 individuals with Parkinson's disease under deep brain stimulation were randomly assigned into two groups including Dexmedetomidine and Propofol that referring to Assistant Professor of Anesthesiology Taleghani Hospital in 2016. In the implementation phase. The following drugs were used: Dexmedetomidine (Precedex) with dose of 0.2-0.4 μ/kg/h and Propofol with doses of 20-30 mg bolus, and then 10-20 μ/kg/min infusion, with a control and preservation of BIS between 65 and 85, and also, RAMSY Sedation Score equal to 3. Locus of pin and the head scalp were anaesthetized with lidocaine drug. The total dose of local anaesthetic drugs was recorded at the end of the procedure. The interval time between drug discontinuation and start of tremor, and also, the time of emergence, was recorded as the time between relaxation and when the patient is able to cooperate for a neurological examination. All of the events during the operation and complications and complains of pain and restlessness were recorded. Moreover, the following cases were investigated Post-operative pain, vital signs, and hemodynamic changes, respiratory and alert status of patients for 2 hours in PACU. Patients' pain was measured using VAS (0: painless, 10: maximum pain) at intervals of 30 minutes. Independent t-test and Mann-Whitney test were used for data analysis. Findings showed that there was a significant difference between time to tremor and time to cooperation variables in the two groups. Mean comparison showed that the mean time to tremor and time to cooperation in the Propofol group was higher than the Dexmedetomidine (DEX) group. Other findings showed that there was no significant difference between BIS in the two groups. The results also showed that there was a significant difference between VAS and surgeon satisfaction variables in the two groups. Mean VAS in Propofol group was significantly higher than DEX group. Mean of surgeon satisfaction in the DEX group was significantly higher than Propofol group. In general, it can be said that patients with Parkinson's disease, Dexmedetomidine is superior drug to Propofol to deep brain stimulation.

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Section: Discussionsupporting

confidence: 81%

Comparison of the Effect of Dexmedetomidine and Propofol on Duration of Starting Tremor after Drug discontinuation in Parkinson's Patients under Deep Brain stimulation

Behnaz¹,

Ghasemi²,

Shabanpour³

2018

JMBR

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“…Additionally, 50-100 ml/h of normal saline is provided intravenously. Dexmedetomedine has been extensively examined recently as a substitute for propofol to provide conscious sedation due to its positive effects, such as sedation without respiratory depression and a shorter arousal time [27].…”

Section: In the Operating Roommentioning

confidence: 99%

Awake craniotomy for brain tumor: indications, technique and benefits

Dziedzic

Bernstein

2014

Expert Review of Neurotherapeutics

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Increasing interest in the quality of life of patients after treatment of brain tumors has led to the exploration of methods that can improve intraoperative assessment of neurological status to avoid neurological deficits. The only method that can provide assessment of all eloquent areas of cerebral cortex and white matter is brain mapping during awake craniotomy. This method helps ensure that the quality of life and the neuro-oncological result of treatment are not compromised. Apart from the medical aspects of awake surgery, its economic issues are also favorable. Here, we review the main aspects of awake brain tumor surgery. Neurosurgical, neuropsychological, neurophysiological and anesthetic issues are briefly discussed.

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“…All of these have been discussed in the literature. 15,16,24,31,32,35 The first two of these techniques have previously been applied at the Department of Neurosurgery, University Hospital of Münster. Given recent publications, we decided to maintain the nomenclature "conscious sedation."…”

mentioning

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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Comparison of Dexmedetomidine and Propofol for Conscious Sedation in Awake Craniotomy

Abstract: Either DEX or PRO can be effectively and safely used for conscious sedation in awake craniotomy. Comparing the two, DEX produced a shorter arousal time and a higher degree of surgeon satisfaction.

Cited by 49 publications

References 30 publications

Comparison of the Effect of Dexmedetomidine and Propofol on Duration of Starting Tremor after Drug discontinuation in Parkinson's Patients under Deep Brain stimulation

Comparison of the Effect of Dexmedetomidine and Propofol on Duration of Starting Tremor after Drug discontinuation in Parkinson's Patients under Deep Brain stimulation

Awake craniotomy for brain tumor: indications, technique and benefits

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

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