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Dexmedetomidine for awake craniotomy: Systematic review and meta-analysis
Phuping Akavipat1, Pimwan Sookplung1, Varinee Lekprasert2
1Department of Anesthesiology, Neurological Institute of Thailand, Bangkok 10400, Thailand.
Summary
Dexmedetomidine-based monitored anesthesia care (MAC) is effective and safe for awake craniotomy. This systematic review found no significant differences in outcomes but noted fewer intraoperative seizures with dexmedetomidine.
Area of Science:
- Neurosurgery
- Anesthesiology
- Evidence-Based Medicine
Background:
- Monitored anesthesia care (MAC) is preferred for awake craniotomy due to lower failure rates.
- Optimal anesthetic agents and complication profiles for MAC in awake craniotomy remain unclear.
Purpose of the Study:
- To systematically review and compare clinical profiles, surgical outcomes, and anesthesia-related complications of dexmedetomidine-based versus non-dexmedetomidine regimens for awake craniotomy under MAC.
Main Methods:
- A systematic review and meta-analysis of published clinical trials (Jan 2009–Mar 2022) from PubMed, Scopus, Google Scholar, and grey literature.
- Included 2,137 patients undergoing awake craniotomy for epilepsy surgery, deep brain stimulation, or intracranial surgery near eloquent areas.
- Followed PRISMA guidelines with PROSPERO registration; compared relative risks (RR) for outcomes and complications.
Main Results:
- No statistically significant differences were found in surgical outcomes (RR 1.08), conversion to general anesthesia (RR 0.45), respiratory complications (RR 0.4), or intraoperative nausea/vomiting (RR 0.30).
- The incidence of intraoperative seizures was significantly higher in the non-dexmedetomidine group (RR 4.26).
Conclusions:
- Dexmedetomidine-based MAC appears effective and safe for awake craniotomy.
- Further randomized controlled trials with standardized protocols are needed to confirm dexmedetomidine's specific benefits in various patient groups and surgical procedures.
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