Document Detail


Dexmedetomidine and neurocognitive testing in awake craniotomy.
MedLine Citation:
PMID:  14676565     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Patients are selected for awake craniotomy when the planned procedure involves eloquent areas of the brain, necessitating an awake, cooperative patient capable of undergoing neurocognitive testing. Different anesthetic combinations, including neurolept, propofol with or without opioid infusions, and asleep-awake-asleep techniques, have been reported for awake craniotomy. In all these techniques, respiratory depression has been reported as a complication. In this case series dexmedetomidine, the highly selective alpha-2 adrenoreceptor agonist, was selected for its lack of respiratory depression as well as its sedative and analgesic properties. The charts of 10 consecutive patients who underwent awake craniotomy with dexmedetomidine infusion were reviewed. Five of the patients underwent "asleep-awake" technique with a laryngeal mask airway and volatile agent. Five patients received moderate to conscious sedation. All patients received a dexmedetomidine load of 0.5 to 1.0 microg/kg over 20 minutes followed by an infusion at rates of 0.01 to 1.0 microg/kg per hour. Four patients had extensive sensory and motor testing, and six underwent neurocognitive testing, including naming, reading, counting, and verbal fluency. There were no permanent neurologic deficits, except one patient who had an exacerbation of preoperative language difficulties. Dexmedetomidine appears to be a useful sedative for awake craniotomy when sophisticated neurologic testing is required.
Authors:
Patricia Fogarty Mack; Kenneth Perrine; Erik Kobylarz; Theodore H Schwartz; Cynthia A Lien
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of neurosurgical anesthesiology     Volume:  16     ISSN:  0898-4921     ISO Abbreviation:  J Neurosurg Anesthesiol     Publication Date:  2004 Jan 
Date Detail:
Created Date:  2003-12-16     Completed Date:  2004-04-02     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8910749     Medline TA:  J Neurosurg Anesthesiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  20-5     Citation Subset:  IM    
Affiliation:
Weill Medical College of Cornell University, New York, New York 10021, USA. pmack@med.cornell.edu
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MeSH Terms
Descriptor/Qualifier:
Adrenergic alpha-Agonists / therapeutic use
Adult
Aged
Aged, 80 and over
Brain Neoplasms / surgery*
Conscious Sedation / methods*
Craniotomy / methods*
Deuterium Oxide
Dexmedetomidine / therapeutic use*
Female
Humans
Hypnotics and Sedatives / therapeutic use*
Intraoperative Complications / diagnosis,  etiology
Male
Middle Aged
Monitoring, Intraoperative / methods
Neuropsychological Tests*
Wakefulness / drug effects
Chemical
Reg. No./Substance:
0/Adrenergic alpha-Agonists; 0/Hypnotics and Sedatives; 113775-47-6/Dexmedetomidine; 7789-20-0/Deuterium Oxide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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