Effect of Low-Dose Dexmedetomidine on the Anesthetic and Recovery Profile of Sevoflurane-Based Anesthesia in Patients Presenting for Supratentorial Neurosurgeries: A Randomized Double-Blind Placebo-Controlled Trial

Unnikrishnan Prathapadas, Ajay Prasad Hrishi, Arulvelan Appavoo, Smita Vimala, Manikandan Sethuraman
Journal of Neurosciences in Rural Practice 2020, 11 (2): 267-273
Background  Dexmedetomidine could be a suitable adjuvant in neuroanesthesia due to its analgesic and anesthetic-sparing properties with the added advantage of facilitating intraoperative neuromonitoring. However, its recovery profile is still debated upon, as in neuroanesthesia, a prompt recovery is essential for postoperative neurologic assessment. We designed this study to evaluate the effect of dexmedetomidine on the anesthetic and recovery profile of patients presenting for supratentorial neurosurgeries. Materials and Methods  Forty adult patients undergoing supratentorial surgeries were recruited in this prospective, randomized, double-blinded study and were divided into two groups: group S and group SD. Both groups received sevoflurane and fentanyl for maintenance, whereas group SD alone received a low dose of dexmedetomidine infusion. Recovery parameters, opioid consumption, Richmond Agitation-Sedation Scale (RASS) and visual analogue scale (VAS) scores, incidence of nausea and vomiting, and intraoperative hemodynamics were analyzed. Results   There were no statistically significant differences between the groups S and SD in case of recovery parameters-time taken (in minutes, presented as median with interquartile range [IQR]) for (1) eye-opening to command: 9.5 (8-18) versus 22.5 (5-47.5) ( p = 0.414); 2) following verbal command: 10.5 (8.25-29.5) versus 25 (10-28.75) ( p = 0.512); (3) extubation: 11 (9.25-22) versus 25 (10-30) ( p = 0.277); and (4) getting oriented to place, time, and date: 23 (20-52.75) versus 27.5 (25-36.5) ( p = 0.121). Fentanyl consumption was significantly less in group SD (451 ± 39.3) versus group S (524.3 ± 144.1) ( p = 0.034). The median RASS score with IQR and the median VAS scores with IQR were comparable between the groups at all time points. Of the 20 patients in group S, 5 had complaints of nausea and vomiting compared with none in the group SD, although it was not statistically significant. The hemodynamic parameters did not show a significant difference between the groups except for a surge in mean arterial pressure at 30 minutes in group S. Conclusion  Low-dose dexmedetomidine as an adjuvant to sevoflurane- and fentanyl-based anesthesia could provide stable hemodynamics and lesser anesthetics and opioid consumption, without adversely affecting the recovery profile in patients undergoing supratentorial neurosurgical procedures.

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