title: Post-operative dexmedetomidine-based sedation after uneventful intracranial surgery for unruptured cerebral aneurysm: comparison with propofol-based sedation.
abstract: BACKGROUND
  Clinical applications of dexmedetomidine (DEX) for neurosurgical procedures have not been adequately investigated. This study aimed to test the use of DEX infusion, alone or as an adjunct to propofol infusion, as compared to propofol infusion in patients with an unruptured cerebral aneurysm after uneventful intracranial procedures.
  
  
  METHODS
  In this retrospective observational study from a single institute, of 184 patients who underwent uneventful intracranial procedures for an unruptured cerebral aneurysm between January 2003 and March 2007, we reviewed 50 managed with DEX-based sedation (DEX alone or as an adjunct to propofol infusion) between April 2005 and March 2007, and 50 managed with propofol-based sedation (propofol alone) between January 2003 and April 2005. With DEX-based sedation, both intubated and extubated patients received DEX infusion at an initial dose of 0.4 μg/kg/h, followed by a maintenance dose of 0.2-0.7 μg/kg/h. Propofol was used in both groups at a dose range of 0.5-5.0 mg/kg/h. Hemodynamic variables, including heart rate (HR) and blood pressure (BP), and adverse events were recorded and compared between the groups.
  
  
  RESULTS
  HR during sedation and systolic BP at 2 h after beginning sedation were significantly lower in the DEX group. No serious adverse events were observed. In the DEX group, 66% were sedated in combination with propofol, of whom 94% were intubated.
  
  
  CONCLUSIONS
  DEX could be used safely for both intubated and extubated patients following uneventful intracranial procedures for an unruptured cerebral aneurysm, though it significantly reduced HR. Our findings also indicate that it is preferable to add low-dose propofol to DEX for management of intubated patients.
authors.affiliation: Department of Neurosurgery, Higashiosaka City General Hospital, 3-4-5 Nishiiwata, Higashiosaka, Osaka, 578-8588, Japan. hyokota0001@gmail.com
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yokota
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yokoyama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Noguchi
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Nishioka
authors.forename: Osamu
authors.initials: O
authors.lastname: Umegaki
authors.forename: Hisao
authors.initials: H
authors.lastname: Komatsu
authors.forename: Toshisuke
authors.initials: T
authors.lastname: Sakaki
mesh_terms: D058647:Adrenergic alpha-2 Receptor Agonists / Q000008:administration & dosage / Q000009:adverse effects; D000368:Aged; D020927:Dexmedetomidine / Q000008:administration & dosage* / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D002532:Intracranial Aneurysm / Q000601:surgery*; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*; D015742:Propofol / Q000009:adverse effects; D012189:Retrospective Studies
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D015742:Propofol