Acta neurochirurgica · 2026
Dexmedetomidine versus propofol for sedation in awake neurosurgery: respiratory and hemodynamic safety.
СтатьяНаблюдательное исследованиеСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Levé Charlotte, Vallée Fabrice, Aubrun Sylvie, Levavasseur Séverine, Rajaona Mickael, El Ayeb Kanssaa, Mandonnet Emmanuel, Touchard Cyril, Mateo Joaquim, Cartailler Jérôme, Joachim Jona
Аннотация
PURPOSE: Monitored anesthesia care (MAC) with continuous sedation for awake craniotomy allows rapid recovery but increases risks of hypoventilation and hypoxemia. In April 2019, our center replaced propofol-based sedation with dexmedetomidine-based protocols to improve respiratory safety. We evaluated the impact of this protocol change on respiratory and hemodynamic outcomes.
METHODS: This single-center retrospective before-after observational study analyzed all adult patients undergoing awake craniotomy between April 2017 and July 2021. The propofol group (April 2017-March 2019) received propofol-remifentanil sedation; the dexmedetomidine group (April 2019-July 2021) received dexmedetomidine-based sedation with supplemental low-dose propofol. Primary endpoints were hypoxemia (SpO2 < 92%) and hypercarbia (PaCO2 and transcutaneous PCO2). Secondary endpoints included hemodynamic stability and adverse events.
RESULTS: We included 103 patients (51 propofol, 52 dexmedetomidine). Desaturation below 92% occurred more frequently in the propofol group (40% vs. 17%, p = 0.04). PaCO2 levels were significantly lower with dexmedetomidine across all sedation periods (period 1: 52 ± 0.9 vs. 64 ± 2 mmHg, p < 0.0001; period 2: 52 ± 1 vs. 66 ± 2 mmHg, p = 0.0002; period 4: 48 ± 0.8 vs. 51 ± 1 mmHg, p = 0.03). Mean arterial pressure was higher and less variable in the dexmedetomidine group (p < 0.01). Blood loss exceeding 500 mL was more common with propofol (41% vs. 19%, p = 0.027). Mapping conditions were excellent in both groups (96%).
CONCLUSIONS: In this single-center retrospective study, transitioning from propofol-based to dexmedetomidine-based sedation for awake craniotomy was associated with improved respiratory and hemodynamic safety.
METHODS: This single-center retrospective before-after observational study analyzed all adult patients undergoing awake craniotomy between April 2017 and July 2021. The propofol group (April 2017-March 2019) received propofol-remifentanil sedation; the dexmedetomidine group (April 2019-July 2021) received dexmedetomidine-based sedation with supplemental low-dose propofol. Primary endpoints were hypoxemia (SpO2 < 92%) and hypercarbia (PaCO2 and transcutaneous PCO2). Secondary endpoints included hemodynamic stability and adverse events.
RESULTS: We included 103 patients (51 propofol, 52 dexmedetomidine). Desaturation below 92% occurred more frequently in the propofol group (40% vs. 17%, p = 0.04). PaCO2 levels were significantly lower with dexmedetomidine across all sedation periods (period 1: 52 ± 0.9 vs. 64 ± 2 mmHg, p < 0.0001; period 2: 52 ± 1 vs. 66 ± 2 mmHg, p = 0.0002; period 4: 48 ± 0.8 vs. 51 ± 1 mmHg, p = 0.03). Mean arterial pressure was higher and less variable in the dexmedetomidine group (p < 0.01). Blood loss exceeding 500 mL was more common with propofol (41% vs. 19%, p = 0.027). Mapping conditions were excellent in both groups (96%).
CONCLUSIONS: In this single-center retrospective study, transitioning from propofol-based to dexmedetomidine-based sedation for awake craniotomy was associated with improved respiratory and hemodynamic safety.