Dexmedetomidine vs propofol as sedation for implantation of neurostimulators: A single‐center single‐blinded randomized controlled trial

Abstract

Background:During the lead implantation of most spinal cord neurostimulators, the patient has to be comfortable and without pain. However, the patient is expected to provide feedback during electrical mapping. Titrating sedatives and analgesics for this double goal can be challenging. In comparison with our standard sedative agent propofol, the pharmacological profile of dexmedetomidine is more conducive to produce arousable sedation. The latter, however, is associated with hemodynamic side effects. We investigated whether dexmedetomidine is preferable over propofol during neurostimulator implantation.Methods: This single-center single-blinded randomized controlled trial included 72 patients with an indication for a neurostimulator, randomized to sedation with either propofol (0.5 mg/kg for 10 minutes, followed by 2.0 mg/kg/h) or dexmedetomidine (1 μg/kg for 10 minutes, followed by 0.6 μg/kg/h). The primary outcome was patient satisfaction with the sedation. The secondary outcomes were patient's and operator's comfort, number of titration adjustments, standard intraoperative hemodynamic and respiratory parameters and side effects. Results: Data of 69 patients (dexmedetomidine n = 35; propofol n = 34) were analyzed. Those receiving dexmedetomidine were more satisfied with the sedation than those receiving propofol; i.e. with sedation delivery (median 100.0 vs 83.3, P < .01), procedural recall (median 95.8 vs 83.3, P = .03), and sedation side effects (median 90.0 vs 83.3, P = .01). Fewer changes in the dexmedetomidine titration were necessary to maintain arousable sedation. Over time, mean arterial pressure and heart rate were significantly lower in the dexmedetomidine group. Hemodynamic side effects were comparable across groups.Conclusions: Dexmedetomidine sedation resulted in higher patient satisfaction and allowed for better arousable sedation than sedation with propofol. Although differences in hemodynamic parameters were found between the groups, these differences were not regarded as clinically relevant. 1322 | ter BrUGGeN et al. S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: ter Bruggen FFJA, Ceuppens C, Leliveld L, Stronks DL, Huygen FJPM. Dexmedetomidine vs propofol as sedation for implantation of neurostimulators: A single-center single-blinded randomized controlled trial. Acta

Effects of Intraoperative Dexmedetomidine Infusion on Postoperative Pain after Craniotomy: A Narrative Review

“…However, the focus in healthcare should be on the value of care for the patient [ 37 ]. In a neurostimulator implantation study by ter Bruggen et al [ 38 ], the sedation costs of intraoperative use of DEX were more expensive when compared to Propofol. Nevertheless, the sedation costs represented less than 0.5% of the whole cost for the procedure, with the cost difference being significant but factually small.…”

Common challenges in cochlear implant surgery performed under local anaesthesia and how to overcome them: the experience of UK surgeons

“…4,14 Concerns raised by our UK cohort of surgeons primarily surrounded the risk of unpredictable sedation. Dexmedetomidine, not currently licensed for operating theatre use in the UK, has been shown to achieve co-operative sedation, 18 with better arousable sedation compared to propofol, 19 and associated with better analgesia and post-operative pain scores 20 and fewer respiratory adverse events. 21 Our cohort of surgeons recommended various techniques to control intra-operative pain, including advice on achieving adequate LA at the start of the procedure with a wide range of possible LA agents.…”

“…4,14 Concerns raised by our UK cohort of surgeons primarily surrounded the risk of unpredictable sedation. Dexmedetomidine, not currently licensed for operating theatre use in the UK, has been shown to achieve co-operative sedation, 18 with better arousable sedation compared to propofol, 19 and associated with better analgesia and post-operative pain scores 20 and fewer respiratory adverse events. 21…”

Long-Term Effects of Dexmedetomidine versus Propofol During the Implantation of a Neurostimulator—A Post-Trial Follow-Up Analysis

“…The results indicated a safe and stable situation for both patient groups during the procedure. 11 A sedation that is too shallow can cause discomfort for the patient and the implantation team, which is to the detriment of the placement technique of the leads. A poorly awake patient during testing can lead to an inadequate assessment of the position of the leads.…”