Dexmedetomidine Indications

• Association of Early Dexmedetomidine Utilization With Clinical and Functional Outcomes Following Moderate-Severe Traumatic Brain Injury: A Transforming Clinical Research and Knowledge in Traumatic Brain Injury Study
• Anesthesia for same day neurosurgery with updates on awake craniotomy and awake spine surgery
• Awake craniotomies in the pediatric population: a systematic review
• Prolonged Infusion of Dexmedetomidine in Critically-ill Children
• Patients selection for awake neurosurgery
• Awake craniotomy. Considerations in special situations

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 ¹⁾.

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 sedatives/narcotics to facilitate extubation.

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 ²⁾.

Dexmedetomidine for awake craniotomy.

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 ³⁾.

DEX sedation for interventional pain management during procedures such as gasserian ganglion block may be useful ⁴⁾.

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 ⁵⁾.

Intravenous DEX exhibits synergism with regional anesthesia and facilitates postoperative pain control ^{6) 7)}.

Monitored anesthesia care using dexmedetomidine without loading dose for embolization of intracranial aneurysms appeared to be a safe and effective alternative to general anesthesia ⁸⁾.

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 ⁹⁾.

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 ¹⁰⁾.