====== Dexmedetomidine Indications ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1z52wgQGrym42V9CByLeCfU0bHUiXWZr2GNVWZkwuab19c_gKg/?limit=15&utm_campaign=pubmed-2&fc=20240816080755}}

Goals of [[anesthesia]] in neurosurgery include stable [[cerebral hemodynamics]] and provide relaxed brain to surgeon. Dexmedetomidine and [[lignocaine]] as an adjuvant can fulfill these criteria but literature comparing the two are sparse.
Dexmedetomidine as an adjuvant to anesthetic drugs has a better profile than lignocaine in suppressing stress response and preventing hemodynamic variations at intubation, skull pin application, and surgical incision. Dexmedetomidine increases the duration of effective analgesia more than lignocaine, in postoperative period in patients undergoing craniotomy
((Shekhar S, Goyal N, Mirza AA, Agrawal S. Evaluation of effects of intravenous infusion of dexmedetomidine or lignocaine on stress response and postoperative pain in patients undergoing craniotomy for intracranial tumors: A randomized controlled exploratory study. Saudi J Anaesth. 2024 Jul-Sep;18(3):402-409. doi: 10.4103/sja.sja_141_24. Epub 2024 Jun 4. PMID: 39149745; PMCID: PMC11323921.)).
----


Dexmedetomidine (Precedex®). [[Alpha 2 adrenergic receptor]] agonist, used for control of [[hypertension]] postoperatively, as well as for its sedating qualities during [[awake craniotomy]] either alone or in conjunction with [[propofol]]. Also used to help patients tolerate [[endotracheal tube]] without [[sedative]]s/[[narcotic]]s to facilitate [[extubation]].

==== Chronic subdural hematoma ====
Dexmedetomidine-based sedation compared to propofol, along with scalp block for monitored anaesthesia care (MAC) in patients undergoing [[burr hole]] [[evacuation]] of CSDH is associated with haemodynamic stability and greater surgeon satisfaction
((Srivastava VK, Agrawal S, Kumar S, Khan S, Sharma S, Kumar R. Comparative
Evaluation of Dexmedetomidine and Propofol Along With Scalp Block on Haemodynamic
and Postoperative Recovery for Chronic Subdural Haematoma Evacuation Under
Monitored Anaesthesia Care. Turk J Anaesthesiol Reanim. 2018 Feb;46(1):51-56.
doi: 10.5152/TJAR.2018.16878. Epub 2018 Feb 1. PubMed PMID: 30140501; PubMed
Central PMCID: PMC5858890.
)).

===== Awake craniotomy =====

[[Dexmedetomidine for awake craniotomy]].


===Sedation===
Dexmedetomidine is safer and equally effective agent compared to propofol and midazolam for sedation of neurosurgical mechanically ventilated patients with good hemodynamic stability and extubation time as rapid as propofol. Dexmedetomidine also reduced postoperative fentanyl requirements
((Srivastava VK, Agrawal S, Kumar S, Mishra A, Sharma S, Kumar R. Comparison of 
dexmedetomidine, propofol and midazolam for short-term sedation in
postoperatively mechanically ventilated neurosurgical patients. J Clin Diagn Res.
2014 Sep;8(9):GC04-7. doi: 10.7860/JCDR/2014/8797.4817. Epub 2014 Sep 20. PubMed 
PMID: 25386451; PubMed Central PMCID: PMC4225903.
)).

DEX sedation for interventional pain management during procedures such as gasserian ganglion block may be useful
((Kido H, Komasawa N, Fujiwara S, Hyoda A, Morimoto K, Minami T. [Gasserian
ganglion block for trigeminal neuralgia under dexmedetomidine sedation]. Masui.
2014 Aug;63(8):901-3. Japanese. PubMed PMID: 25199328.)).

===Postoperative pain control===
Intraoperative dexmedetomidine infusion was effective for reducing pain and analgesic consumption after craniotomy. In addition, dexmedetomidine may help to reduce postoperative nausea and vomiting (PONV) in patients after craniotomy treated with tramadol postoperatively. Chinese Clinical Trial Register identifier: ChiCTR-TRC-13003598
((Peng K, Jin XH, Liu SL, Ji FH. Effect of Intraoperative Dexmedetomidine on
Post-Craniotomy Pain. Clin Ther. 2015 Mar 10. pii: S0149-2918(15)00077-6. doi:
10.1016/j.clinthera.2015.02.011. [Epub ahead of print] PubMed PMID: 25769614.)).

Intravenous DEX exhibits synergism with regional anesthesia and facilitates postoperative pain control 
((Adams R, Brown GT, Davidson M, Fisher E, Mathisen J, et al. (2013) Efficacy of dexmedetomidine compared with midazolam for sedation in adult intensive care patients: a systematic review. British journal of anaesthesia 111: 703–710))
((Abdallah FW, Abrishami A, Brull R (2013) The facilitatory effects of intravenous dexmedetomidine on the duration of spinal anesthesia: a systematic review and meta-analysis. Anesthesia and analgesia 117: 271–278)).

Monitored anesthesia care using dexmedetomidine without loading dose for embolization of intracranial aneurysms appeared to be a safe and effective alternative to general anesthesia
((Lee HH, Jung YJ, Choi BY, Chang CH. Usefulness of Dexmedetomidine during
Intracerebral Aneurysm Coiling. J Korean Neurosurg Soc. 2014 Apr;55(4):185-9.
doi: 10.3340/jkns.2014.55.4.185. Epub 2014 Apr 30. PubMed PMID: 25024820; PubMed 
Central PMCID: PMC4094741.
)).


Dexmedetomidine is useful during intraoperative [[electrocorticography]] (ECoG) recording in [[epilepsy surgery]] as it enhances or does not alter spike rate in most of the cases, without any major adverse effects.

Dexmedetomidine is a option for treatment of acute severe [[baclofen]] withdrawal
((Morr S, Heard CM, Li V, Reynolds RM. Dexmedetomidine for Acute Baclofen
Withdrawal. Neurocrit Care. 2014 Nov 18. [Epub ahead of print] PubMed PMID:
25403764.)). 

Microelectrode recordings in pediatric DBS can be preserved with a combination of dexmedetomidine and ketamine, remifentanil, and nicardipine. This preservation of MERs is particularly crucial in electrode placement in children
((Hippard HK, Watcha M, Stocco AJ, Curry D. Preservation of microelectrode
recordings with non-GABAergic drugs during deep brain stimulator placement in
children. J Neurosurg Pediatr. 2014 Sep;14(3):279-86. doi:
10.3171/2014.5.PEDS13103. Epub 2014 Jul 4. PubMed PMID: 24995822.)).