Use of Dexmedetomidine in a Patient Allergic to Clonidine Presenting for an Awake Craniotomy: a Case Report

Abstract

Introduction: The use of dexmedetomidine with concurrent scalp block is increasingly being utilized as an effective and safe anesthetic approach for awake craniotomy (AC). Dexmedetomidine is an alpha-2 adrenergic receptor (α2-AR) agonist with dose-dependent sedative, analgesic, and anxiolytic properties while preserving respiratory function. The challenge with the use of dexmedetomidine arises when the patient in question has a clonidine allergy that is also an α2-AR agonist. Currently there aren't any published literature regarding the use of dexmedetomidine in a patient allergic to clonidine.Case Presentation: A 48-year-old male with chronic obstructive pulmonary disease, obstructive sleep apnea, and body mass index of 54 with clonidine allergy presents for an AC. Given the goals of the surgery and patient comorbidities, we planned for monitored anesthesia care with intravenous (IV) dexmedetomidine, remifentanil, and propofol. We discussed the use of dexmedetomidine with the patient and the potential risk of allergic reaction given his allergy to clonidine. Patient understood the risk and consented to the anesthetic plan. AC was successfully performed with IV dexmedetomidine, remifentanil, and propofol. Conclusion: Although both dexmedetomidine and clonidine have some functional similarities in terms of acting on the central and peripheral nervous system, there are marked differences between the two based on chemical structure, receptor a nity, and metabolism of the drug. This case highlights the successful use of dexmedetomidine in a patient with known allergy of rash to clonidine.

Awake craniotomies in South America: Advancements, challenges, and future prospects

“… 11 Specialised procedures like ACs necessitate close collaboration and communication with neuroscientists and psychologists, requiring cognitive tests to assess patient functioning before the craniotomy procedure. 39 Compared to HICs, there is a general deficiency of office space, staff, and funding needed to conduct such specialised neurocognitive tests, further hindering the successful implementation of AC programs into mainstream South American practice. 11 …”