Dexmedetomidine sedation for carotid endarterectomy

General anaesthesia and deep sedation during endarterectomy exclude direct contact with the patient, required for safe performance of the surgery. The aim of the study was to assess sedation with dexmedetomidine and its cardiovascular effects.

Sixty-four adult patients, scheduled on internal carotid artery surgery under infiltration analgesia, were randomly divided to receive dexmedetomidine in the loading dose of 1 microg kg(-1) over 10 min, followed by 0.2 microg kg(-1) h(-1) continuous infusion (group D) or placebo (group P).The BIS score, heart rate (HR) and mean arterial pressure (MAP) were noted.

In the group D, during carotid artery clamping (CAC) mean BIS scores were lower, compared to the baseline and to the values recorded in the group P. The BIS scores in the group P did not differ from baseline. In the group D, we did not observe cardiovascular reactions that could be attributed to CAC; in the group P, MAP and HR increased during CAC, and returned to normal 10 min after clamp release. Significant decrease of HR was observed after 12 min of dexmedetomidine infusion, at 10 and 15 min after CAC in group D. Urapidil and fentanyl were administered more often in the placebo group.

The 0.2 microg kg(-1) h(-1) dexmedetomidine infusion, administered during carotid endarterectomy, secured cardiovascular stability and reduced the need for additional analgesia.