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CC BY 4.0 · J Neuroanaesth Crit Care 2023; 10(02): 087-093
DOI: 10.1055/s-0042-1748195
Original Article

Comparison of Monitored Anesthesia Care with Propofol Versus Dexmedetomidine for Awake Craniotomy: A Retrospective study

Keta Thakkar 
1   Department of Neuroanaesthesia, Christian Medical college, Vellore, Tamil Nadu, India
,
Ramamani Mariappan 
1   Department of Neuroanaesthesia, Christian Medical college, Vellore, Tamil Nadu, India
,
Krishna Prabhu 
2   Department of Neurosurgery, Christian Medical college, Vellore, Tamil Nadu, India
,
Bijesh Yadav 
3   Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
,
Georgene Singh 
1   Department of Neuroanaesthesia, Christian Medical college, Vellore, Tamil Nadu, India
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Abstract

Background Anesthetic agents used for awake craniotomy should be safe, short-acting, titratable, and provide an adequate level of sedation and analgesia, along with facilitating adequate neurological assessment during the functional testing. Our study aims to review the efficacy and safety profile, along with the potential for neurophysiological monitoring, of two commonly used anesthetic regimens, i.e., propofol and dexmedetomidine.

Methods After the Ethics Committee approval, a retrospective analysis of 51 patients who underwent awake craniotomy for brain tumor excision over a period of 7 years was done. Those who received monitored anesthesia care (MAC) were divided into two groups, namely, Group P for that received propofol, and Group D that received dexmedetomidine and their hemodynamic profile, perioperative complications, neuromonitoring techniques, and postoperative course was noted from the records.

Results A total of 31 patients were administered MAC with propofol and 20 with dexmedetomidine. The baseline demographic data, duration of surgery, intensive care unit (ICU), and hospital stay were comparable between the two. The hemodynamic profile as assessed by the heart rate and blood pressure was also comparable. The incidence of intraoperative seizures was found to be less in Group P, though. Episodes of transient desaturation were observed more in Group P (9.7%) than in Group D (5%), but none of the patients required conversion to general anesthesia. Direct cortical stimulation was satisfactorily elicited in 80% in Group P and 85% in Group D.

Conclusion MAC with propofol and dexmedetomidine are acceptable techniques with comparable hemodynamic profile, intraoperative and postoperative complications, and potential for neurophysiological monitoring.

Keywords

awake craniotomy - eloquent area - propofol - dexmedetomidine - scalp block - seizures


Publication History

Article published online:
25 July 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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