Dexmedetomidine as adjunct in awake craniotomy - improvement or not?

Area of Science:

• Neurosurgery
• Anesthesiology
• Neuro-oncology

Background:

• Awake craniotomy is a standard procedure for brain tumor resection to maximize tumor removal and minimize neurological deficits.
• Optimal anesthetic techniques for awake craniotomy remain under investigation, with no established consensus.
• Dexmedetomidine is explored as an adjunct to improve patient outcomes during these procedures.

Purpose of the Study:

• To evaluate the efficacy of dexmedetomidine as an adjunct in awake cerebral tumor surgery.
• To assess the impact of dexmedetomidine on patient arousal, cooperation, and adverse events.
• To analyze an improved anesthetic technique incorporating dexmedetomidine.

Main Methods:

• Retrospective analysis of patients undergoing awake craniotomy for tumor resection (09/2006-05/2018).
• Comparison of anesthetic regimens: propofol/remifentanil alone versus propofol/remifentanil with dexmedetomidine.
• Evaluation of time to arousal, drug dosages, patient cooperation, and adverse events.

Main Results:

• Seventeen patients received dexmedetomidine (DG) in addition to propofol/remifentanil, compared to 84 patients (SG) on propofol/remifentanil alone.
• The dexmedetomidine group showed significantly reduced propofol infusion time (169.2 vs. 212.9 minutes; P=0.008).
• A non-significant trend towards shorter time to arousal was observed in the dexmedetomidine group (12.0 vs. 15.0 minutes; P=0.271).

Conclusions:

• The asleep-awake technique is a safe and effective procedure for brain tumor resection.
• Dexmedetomidine as an adjunct appears to facilitate faster patient arousal during awake craniotomy.
• The overall procedure was well-tolerated, suggesting dexmedetomidine is a viable option for optimizing awake craniotomy.