Journal article
Comparison of Dexmedetomidine Versus Fentanyl-Based Anesthetic Protocols Under Patient State Index Guidance in Patients Undergoing Elective Neurosurgical Procedures with Intraoperative Neurophysiological Monitoring
Curēus (Palo Alto, CA), Vol.15(3), e35864
03/07/2023
DOI: 10.7759/cureus.35864
PMCID: PMC10078854
PMID: 37033575
Abstract
Objectives
The study was designed to elucidate the effects of dexmedetomidine as an anesthetic adjunct to propofol in total intravenous anesthesia (TIVA) on anesthetic dose reduction, the quality of intraoperative neurophysiological monitoring (IONM) recordings, analgesic requirements, and recovery parameters in patients undergoing neurosurgical procedures with neurophysiological monitoring.
Methods
A total of 54 patients for elective neurosurgical procedures with IONM were randomized to group D (dexmedetomidine) and group F (fentanyl). A loading dose of the study drug of 1µg/kg followed by 0.5 µg/kg/h infusion was used in two groups. Propofol-based TIVA with a Schneider target-controlled infusion model was used for induction and maintenance with effect site concentration of 4-5 and 2.5-4 µg/mL, respectively, titrated to a Patient State Index (PSI) of 25-40. Baseline IONM recordings were obtained after induction. The mean propofol consumption, number of patient movements, quality of IONM recordings, number of fentanyl boluses, hemodynamic characteristics, and recovery parameters were recorded.
Results
The mean propofol consumption was significantly lower in group D when compared to group F (101.4 ± 13.5 µg/kg/min vs 148.0 ± 29.8 µg/kg/min). Baseline IONM recordings were acquired in all patients without any difficulty. The two groups were comparable with respect to the number of additional boluses of fentanyl, patient movements, and recovery characteristics.
Conclusion
Dexmedetomidine as an adjuvant to propofol in TIVA reduces the requirement of the latter, without affecting the IONM recordings. The addition of dexmedetomidine also ensures stable hemodynamics and decreases the requirement of opioids with similar recovery characteristics.
Details
- Title: Subtitle
- Comparison of Dexmedetomidine Versus Fentanyl-Based Anesthetic Protocols Under Patient State Index Guidance in Patients Undergoing Elective Neurosurgical Procedures with Intraoperative Neurophysiological Monitoring
- Creators
- Jerry Jame Joy - Jawaharlal Institute of Post Graduate Medical Education and ResearchPrasanna U Bidkar - Jawaharlal Institute of Post Graduate Medical Education and ResearchSrinivasan Swaminathan - All India Institute of Medical SciencesMukilan Balasubramanian - Cleveland ClinicAnkita Dey - All India Institute of Medical SciencesVivek Chandar Chinnarasan - Jawaharlal Institute of Post Graduate Medical Education and ResearchAdethen Gunasekaran - Jawaharlal Institute of Post Graduate Medical Education and Research
- Resource Type
- Journal article
- Publication Details
- Curēus (Palo Alto, CA), Vol.15(3), e35864
- DOI
- 10.7759/cureus.35864
- PMID
- 37033575
- PMCID
- PMC10078854
- NLM abbreviation
- Cureus
- ISSN
- 2168-8184
- eISSN
- 2168-8184
- Publisher
- Cureus
- Language
- English
- Date published
- 03/07/2023
- Academic Unit
- Anesthesia
- Record Identifier
- 9984845469102771
Metrics
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