Comparison of dexmedetomidine and propofol for conscious sedation in awake
craniotomy: a prospective, double-blind, randomized, and controlled clinical
trial.
Author(s): Shen SL(1), Zheng JY, Zhang J, Wang WY, Jin T, Zhu J, Zhang Q.
Affiliation(s): Author information:
(1)Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China.
Publication date & source: 2013, Ann Pharmacother. , 47(11):1391-9
BACKGROUND: It has been reported that dexmedetomidine (DEX) can be used for
conscious sedation in awake craniotomy, but few data exist to compare DEX versus
propofol (PRO).
OBJECTIVE: To compare the efficacy and safety of DEX versus PRO for conscious
sedation in awake craniotomy.
METHODS: Thirty patients of American Society of Anesthesiologists grade I-II
scheduled for awake craniotomy, were randomized into 2 groups each containing 15
subjects. Group D received DEX and group P received PRO. Two minutes after
tracheal intubation (T1), PRO (target plasma concentration) was titrated down to
1 to 4 µg/mL in group P. In group D, PRO was discontinued and DEX was
administered 1.0 µg/kg followed by a maintenance dose of 0.2 to 0.7 µg/kg/h. The
surgeon preset the anticipated awake point-in-time (T0) preoperatively. Ten
minutes before T0 (T3), DEX was titrated down to 0.2 µg/kg/h in group D, PRO was
discontinued and normal saline (placebo) 5 mL/h was infused in group P. Arousal
time, quality of revival and adverse events during the awake period, degree of
satisfaction from surgeons and patients were recorded.
RESULTS: Arousal time was significantly shorter in group D than in group P (P <
.001). The quality of revival during the awake period in group D was similar to
that of group P (P = .68). The degree of satisfaction of surgeons was
significantly higher in group D than in group P (P < .001), but no difference was
found between the 2 groups with respect to patient satisfaction (P = .80). There
was no difference between the 2 groups in the incidence of adverse events during
the awake period (P > .05).
CONCLUSIONS: Either DEX or PRO can be effectively and safely used for conscious
sedation in awake craniotomy. Comparing the two, DEX produced a shorter arousal
time and a higher degree of surgeon satisfaction.
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