Efficacy and safety of dexmedetomidine infusion for patients undergoing awake craniotomy: An observational study.
Efficacy and safety of dexmedetomidine infusion for patients undergoing awake craniotomy: An observational study.
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DOI：
10.4103/sja.sja_608_17
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发表时间：
2018-04
影响因子：
1.2
通讯作者：
Bithal PK
中科院分区：
文献类型：
--
作者：
Mahajan C;Rath GP;Singh GP;Mishra N;Sokhal S;Bithal PK
清醒开颅手术的目标是维持足够的镇静、镇痛、呼吸和血流动力学稳定性，并为神经系统检查提供合作的患者。一项观察性研究旨在评估右美托咪定镇静对清醒开颅手术的疗效。纳入年龄>18岁、因颅内肿瘤手术接受清醒开颅手术的成年患者。那些不合作且气道困难的患者被排除在研究之外。在手术室中，患者接受右美托咪定 1 μg/kg 的推注剂量，然后输注 0.2–0.7 μg/kg/h（脑电双频指数目标 60–80）。患者镇静后，用0.25%布比卡因进行头皮封闭。收集手术各阶段的血流动力学、术中并发症、芬太尼使用总量、静脉输液量、失血量和输血量、手术持续时间、重症监护病房（ICU）和住院时间等数据。对患者进行格拉斯哥结果量表（GOS）评分和患者满意度评分（PSS）评估。两年内共有 27 名患者接受了清醒开颅手术。最常见的术中并发症是癫痫发作。在 5 名患者（18.5%）中观察到。这些患者均未经历任何饱和度降低的情况。两名患者脑部紧张，需要注射异丙酚。芬太尼平均消耗量为 161.5 ± 85.0 μg。手术时间、ICU时间和住院时间分别为231.5±90.5分钟、14.5±3.5小时和4.7±1.5天。所有患者的总体 PSS 为 8，GOS 良好。在接受清醒开颅手术的患者中使用右美托咪定输注联合局部头皮阻滞是安全有效的。由于没有主要并发症和较高的 PSS，使其接近清醒状态下开颅手术的理想药物。
The goal of awake craniotomy is to maintain adequate sedation, analgesia, respiratory, and hemodynamic stability and also to provide a cooperative patient for neurologic testing. An observational study carried out to evaluate the efficacy of dexmedetomidine sedation for awake craniotomy. Adult patients with age >18 year who underwent awake craniotomy for intracranial tumor surgery were enrolled. Those who were uncooperative and had difficult airway were excluded from the study. In the operating room, the patients received a bolus dose of dexmedetomidine 1 μg/kg followed by an infusion of 0.2–0.7 μg/kg/h (bispectral index target 60–80). Once the patients were sedated, scalp block was given with bupivacaine 0.25%. The data on hemodynamics at various stages of the procedure, intraoperative complications, total amount of fentanyl used, intravenous fluids required, blood loss and transfusion, duration of surgery, Intensive Care Unit (ICU), and hospital stay were collected. The patients were assessed for Glasgow outcome scale (GOS) score and patient satisfaction score (PSS). A total of 27 patients underwent awake craniotomy during a period of 2 years. Most common intraoperative complication was seizures; observed in five patients (18.5%). None of these patients experienced any episode of desaturation. Two patients had tight brain for which propofol boluses were administered. The average fentanyl consumption was 161.5 ± 85.0 μg. The duration of surgery, ICU, and hospital stays were 231.5 ± 90.5 min, 14.5 ± 3.5 h, and 4.7 ± 1.5 days, respectively. The overall PSS was 8 and GOS was good in all the patients. The use of dexmedetomidine infusion with regional scalp block in patients undergoing awake craniotomy is safe and efficacious. The absence of major complications and higher PSS makes it close to an ideal agent for craniotomy in awake state.