A0046 Use of Dexmedetomidine for Prophylactic Analgesia and Sedation in Patients with Delayed Extubation after Craniotomy: A Randomized Double-Blind Controlled Study

Background: In this randomized double-blind controlled study, we evaluated the efficacy and safety of dexmedetomidine for analgesia and sedation in patients with delayed extubation after craniotomy.

Materials and Methods: Sixty patients with delayed extubation after craniotomy were randomized to the group “A” who received a continuous infusion of dexmedetomidine 0.5 µg/kg/h or the group “B” who received a continuous infusion of 0.9% sodium chloride. The mean percentage of time under optimal sedation (sedation agitation score 3–4), the percentage of patients who required rescue with propofol/fentanyl, as well as visual analog score, heart rate, mean arterial pressure, and peripheral oxygen saturation were recorded.

Results: The mean percentage of time under optimal sedation (sedation agitation score 3–4) was significantly higher in the dexmedetomidine group than in the control group (96.7% ± 7.3% versus 91.4% ± 9.8%, p = 0.006). The mean visual analog score was significantly lower in the dexmedetomidine group in comparison to the control group. Heart rate and mean blood pressure were insignificantly lower in the dexmedetomidine group than in the control group. No significant difference in peripheral oxygen saturation was observed between the two groups. For hemodynamic adverse events, patients in the dexmedetomidine group were more likely to develop bradycardia (6.3% versus 0%, p = 0.047) but had a lower likelihood of tachycardia (2.9% versus 18.7%, p = 0.012).

Conclusions: Dexmedetomidine is proved to be an effective prophylactic agent for sedation and analgesia in patients with delayed extubation after craniotomy. The use of dexmedetomidine (0.5 µg/kg/h) infusion does not produce respiratory depression but may increase the incidence of bradycardia.

(Compiled/edited by: Dr. Virendra Jain, Organising Secretary, ISNACC 2019, and Dr. Kiran Jangra, Assistant Professor, Anaesthesiology, PGIMER, Chandigarh.)