Propofol-dexmedetomidine versus propofol-remifentanil conscious sedation for awake craniotomy during epilepsy surgery

Abstract

Background: Conscious sedation during awake craniotomy requires balanced anesthesia technique to achieve optimum sedation and analgesia. This technique should be done without causing respiratory depression or loss of consciousness. The present study aimed at evaluating the effect of propofol-dexmedetomidine versus propofol-remifentanil conscious sedation during awake craniotomy for epilepsy surgery.

Methods: Sixty patients undergoing awake craniotomy for epilepsy surgery were randomly divided into two groups, PD group and PR group. Thirty patients were included in each group. Patients in PD group received propofol and dexmedetomidine intravenous infusion and patients in PR group received propofol and remifentanil intravenous infusion for conscious sedation. Sedation Score, patients' satisfaction, surgeons' satisfaction, heart rate, mean arterial blood pressure, and oxygen saturation were recorded. Side effects such as respiratory depression, nausea, vomiting, airway obstruction, and oxygen desaturation were also recorded.

Results: Sedation Score was higher in PR group compared to PD group (P<0.05). There were no significant differences in patients' satisfaction scores between both groups. The heart rate was lower in the PD group compared to the PR group (P<0.05). The incidences of nausea, vomiting, oxygen desaturation and respiratory depression were statistically higher in PR group compared to PD group (P<0.05).

Conclusions: Propofol-dexmedetomidine combination is as effective as propofol-remifentanil combination but with fewer side effects for conscious sedation during awake craniotomy for epilepsy surgery.