Perspectives on Dexmedetomidine Use for Neurosurgical Patients

Abstract

The α2-adrenergic receptor agonist dexmedetomidine has sedative, anxiolytic, analgesic, and sympatholytic effects. The potential advantages of neuroprotection, minimal impact on neuronal function, stable hemodynamics, opioid and anesthesia sparing effects, and minimal respiratory depression during awake procedures render it an effective anesthetic adjuvant in various neurosurgical settings. However, both the benefits and drawbacks of the use dexmedetomidine in neuroanesthesia should be considered. This narrative review will summarize the applications of dexmedetomidine in various neurosurgical settings, highlighting evidence regarding both its common and controversial uses.

Neuroprotective Effects of Intraoperative Dexmedetomidine Infusion Combined With Goal-directed Hemodynamic Therapy for Patients Undergoing Cranial Surgery: A Double-blinded Randomized Controlled Trial

“…This result is compatible to the literature that dexmedetomidine during cranial surgery may improve arterial pressure stability [8]. However, dexmedetomidine may elevate cerebrovascular resistance through activation of the alpha-2B receptor, resulting in a decrease of cerebral perfusion pressure regardless of arterial pressure stability [11,38]. Furthermore, dexmedetomidine may impede cerebral autoregulation which dissociates arterial pressure and cerebral perfusion [39].…”

“…Hypotension is one of the common adverse effects of dexmedetomidine [11], but we observed stable intraoperative arterial pressure among patients in both study groups with only a slightly higher intraoperative norepinephrine dose (5µg) administrated in patients in the dexmedetomidine group. This result is compatible to the literature that dexmedetomidine during cranial surgery may improve arterial pressure stability [8].…”

“…In addition, the logistic regression model including analysis of baseline neurological status, type of surgery as well as intraoperative pro les revealed potential protective effects of dexmedetomidine. Dexmedetomidine has been reported to mitigate neuroin ammatory cascades, and inhibit catecholamine and glutamate release, thereby preventing regional cerebral ischemia [2,11], which commonly occurs during cranial surgery [1,10]. In addition, plausible mechanisms of neuroprotective effects of dexmedetomidine include the attenuation of neuronal necrosis, apoptosis, autophagy through the effects of an increase of focal adhesion kinase phosphorylation in hippocampus, inducing increases of brain derived neurotrophic factor expression [25] as well as inhibiting lipopolysaccharide-induced astrocyte pyroptosis [26].…”

“…Notably, the literature in which dexmedetomidine use during cranial surgery has primarily focused on the arterial pressure stability [8,9]. Because cranial surgery is associated with increased risk of cerebral ischemia [10] and dexmedetomidine infusion reduces cardiac output and cerebral blood ow [11], this hemodynamic concern may be clinically relevant. Regarding this aspect, the cumulative literature suggests that intraoperative goal-directed hemodynamic therapy (GDHT) for stroke volume optimization improves postcraniotomy outcomes [12][13][14].…”

Enhanced Recovery After Surgery – ERAS in Elective Craniotomies-a Non-randomized Controlled Trial

“…(4) Since then, there have been very few studies reporting successful use of ERAS in nonspinal neurosurgery. (5) 6Here, we describe the use of a modi ed, multidisciplinary ERAS protocol for elective supratentorial surgeries. We aimed at studying the effect of the modi ed ERAS protocol on patients of elective supratentorial tumor surgeries-post operative duration of ICU stay, pain control, analgesic requirement, glygemic control and hospital stay.…”