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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.
Introduction:
For awake craniotomy, monitored anaesthesia care (MAC) had shown relatively lower failure rates. Nevertheless, the conclusion of the appropriate anaesthetic agents, and complications, has not been proposed. Therefore, the systematic review and meta-analysis was done to compare the clinical profile, surgical outcomes, and anesthesia-related complications between dexmedetomidine-based and non-dexmedetomidine regimens during monitored anesthesia care (MAC) for this procedure.
Evidence Acquisition:
Published clinical trials described MAC, including the amount of anaesthetic drugs, or the number of patients for awake craniotomy between January 1st, 2009 and March 31st, 2022 were reviewed through PubMed, Scopus, Google Scholar, and grey literature index. The standard methodological procedures were following the PRISMA statement with the PROSPERO registration. Twenty-two articles with 2,137 awake craniotomy patients identified as epilepsy surgery, deep brain stimulation procedure, and intracranial surgery closed to an eloquent area with intraoperative awakening for neuro-evaluation were included. The relative risk (RR) regarding surgical outcomes, and anaesthesia-related complications were compared.
Evidence Synthesis:
Dexmedetomidine-based versus non-dexmedetomidine anaesthetic regimen revealed no statistically significant differences in surgical outcomes (RR 1.08, 95 %CI 0.94-1.24), conversion to general anaesthesia (RR 0.45, 95 %CI 0.05-3.83), respiratory complications (RR 0.4, 95 %CI 0.12-1.27), and intraoperative nausea and vomiting (RR 0.30, 95 %CI 0.08-1.14). However, the intraoperative seizure was higher in non-dexmedetomidine group (RR 4.26, 95 %CI 1.49-12.16).
Conclusion:
MAC for awake craniotomy with dexmedetomidine seems to be effective and safe. Randomized controlled trials with standard protocol in specific group of patients and surgical interventions would further demonstrate a clear benefit of dexmedetomidine in awake craniotomy under MAC.
Insights
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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