Observation of sedative effects of dexmedetomidine during conscious period of awake craniotomy for seizure resection in the eloquent brain areas of adults

Sun Mei; He Huan; Luan Hanlin; Wu Haopeng; Shi Chong; Tu Weifeng

doi:10.11850/j.issn.1009-122X.2014.11.008

Abstract：Objective To evaluate the sedative effects of continuous injection of dexmedetomidine (Dex) in resection of epileptogenic zone involving eloquent area in adult patients with refractory epilepsy during conscious period under awake anesthesia. Methods Forty-eight adult patients with refractory epilepsy who would accept awake craniotomy for epilepsy focus involving eloquent area were randomly and equally divided into four groups including LP group, LD group, MD group and HD group. The patients in LP group were given dose of 1.5 μg/ml propofol and patients in LD, MD and HD groups were given doses of 0.2 μg/(kg·h), 0.4 μg/(kg·h) and 0.6 μg/(kg·h) Dex in conscious period respectively. The OAA/S, visual analogue scales (VAS), Narcotrend index (NI), heart rate and adverse events were recorded in different time points of conscious period, initiation of sedation (T0), 10 min (T1), 20 min (T2), 30 min (T3), 40 min (T4), 50 min (T5) and 60 min (T6) after sedation. Results All the patients were awaken successfully during surgery. The heart rate of patients in Dex groups were significantly lower than LP group (P < 0.05). The NI in all groups decreased, while NI in all the groups were significant lower after sedation than those at T0 (P < 0.05) and NI in HD group was lower than other groups at T3 (P <0.01). The OAA/S in LD, MD and LP groups remained unchanged over time but the OAA/S in LP group decreased significantly (P <0.05). The OAA/S in HD group was lower than LD and MD groups in all the time points and higher than LP group in all the time points except T1 (P < 0.05). The incidence of shivering was significantly higher in LP and LD groups than MD and HD groups (P <0.05). Conclusion Dex can provide good sedation effect for adult epilepsy patients during conscious period in craniotomy and decrease the incidence of shivering with the dose of 0.4 to 0.6 μg/(kg·h).