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J Neuroanaesth Crit Care 2015; 02(02): 121-126
DOI: 10.4103/2348-0548.155463
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

Dexmedetomidine and propofol for cerebral angiography in non-intubated patients: A comparative study

Sujoy Banik
Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi
,
Pallav Kumar
1   Department of Anaesthesia, Paras Hospital, Gurgaon, Haryana, India
,
Hemanshu Prabhakar
Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi
,
Gyaninder P Singh
Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi
› Author Affiliations
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Publication Date:
02 May 2018 (online)

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Abstract

Context: Patients posted for cerebral angiography may be restless and drowsy with high chance of inadvertent movements. Aims: The primary objective was to compare the incidence of inadvertent movements between propofol and dexmedetomidine groups. The secondary objectives include comparison of recovery time and characteristics, Steward’s score, and haemodynamic and respiratory parameters between the two groups. Settings and Design: Prospective, randomised, double-blind, pilot study. Materials and Methods: In all, 20 adult uncooperative, drowsy patients were randomised to dexmedetomidine (1 μg/kg bolus over 10 minutes followed by 0.3-0.7 μg/kg/hour infusion) or propofol (100 μg/kg/min for 10 minutes followed by 25-75 μg/kg/min infusion). Rate of movement, success of sedation, haemodynamics, respiratory parameters, Steward’s recovery score and recovery time were recorded. Statistical analysis used: Repeated measures of analysis of variance, Mann-Whitney test, independent and paired t-tests, and Fisher test. Results: The median rate of movement was similar (1, P = 0.206) with success of sedation achieved in 7 (70%) patients in Group D and 9 (90%) patients in Group P, which was comparable (P = 0.582). The median recovery time in patients in Group D was 150 (37–764) seconds and in Group P was 128 (54–174) seconds (P = 0.519) with similar Steward’s scores (P = 0.363). Haemodynamics and respiratory variables were well-maintained during loading and maintenance dose infusions in both the groups. Conclusions: Dexmedetomidine is a safe alternative for diagnostic cerebral angiography. Its success of sedation, median rate of movement during the imaging procedure, haemodynamics, respiratory parameters, recovery time and Steward’s recovery score were similar to propofol in our study.

Keywords

Cerebral angiography - dexmedetomidine - non-intubated - propofol - sedation
 

  • REFERENCES

  • 1 Bewlay MA, Laurence AS. Sedation for neuroradiology revisited: Comparison of three techniques for cerebral angiography. Eur J Anaesthesiol 2003; 20: 726-30
    CrossrefPubMedSearch in Google Scholar
  • 2 Heard C, Burrows F, Johnson K, Joshi P, Houck J, Lerman J. A comparison of dexmedetomidine-propofol with midazolam for maintenance of anaesthesia in children undergoing magnetic resonance imaging. Anesth Analg 2008; 107: 1832-9
    CrossrefPubMedSearch in Google Scholar
  • 3 Wu J, Mahmoud M, Schmitt M, Hossain M, Kurth D. Comparison of propofol and dexmedetomedine techniques in children undergoing magnetic resonance imaging. Paediatr Anaesth 2014; 24: 813-8
    CrossrefPubMedSearch in Google Scholar
  • 4 Tosun Z, Akin A, Fuler G, Esmaoglu A, Boyaci A. Dexmedetomidine-ketamine and propofol-ketamine combinations for anesthesia in spontaneously breathing pediatric patients undergoing cardiac catheterization. J Cardiothorac Vasc Anesth 2006; 20: 515-9
    CrossrefPubMedSearch in Google Scholar
  • 5 Mester R, Easley RB, Brady KM, Chilson K, Tobias JD. Monitored anesthesia care with a combination of ketamine and dexmedetomidine during cardiac catheterization. Am J Ther 2008; 15: 24-30
    CrossrefPubMedSearch in Google Scholar
  • 6 Piccioni F, Fanzio M. Management of anaesthesia in awake craniotomy. Minerva Anestesiol 2008; 74: 393-408
    PubMedSearch in Google Scholar
  • 7 Bekker AY, Kaufmann B, Samir H, Doyle W. The use of dexmedetomidine infusion for awake craniotomy. Anesth Analg 2001; 92: 1251-3
    CrossrefPubMedSearch in Google Scholar
  • 8 Steward DJ. A simplified scoring system for the post-operative recovery room. Canada Anaesth Soc J 1975; 2: 111-3
    PubMedSearch in Google Scholar
  • 9 Arain SR, Ebert TJ. The efficacy, side effects and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation. Anesth Analg 2002; 95: 461-6
    Search in Google Scholar
  • 10 Shaukry M, Miller J. Update on dexmedetomidine: Use in nonintubated patients requiring sedation for surgical procedures. Ther Clin Risk Manag 2010; 6: 111-21
    PubMedSearch in Google Scholar
  • 11 Shen SL, Zheng JY, Zhang J, Wang WY, Jin T, Zhu J. et al. Comparison of dexmedetomidine and propofol for conscious sedation in awake craniotomy: A prospective, double-blind, randomized, and controlled clinical trial. Ann Pharmacother 2013; 47: 1391-9
    CrossrefPubMedSearch in Google Scholar
  • 12 Fukuda K, Ichinohe T, Kaneko Y. Is measurement of end-tidal CO2 through a nasal cannula reliable?. Anesth Prog 1997; 44: 23-6
    PubMedSearch in Google Scholar
  • 13 Bustillo MA, Lazar RM, Finck AD, Fitzsimmons B, Berman MF, Pile-Spellman J. et al. Dexmedetomidine may impair cognitive testing during endovascular embolization of cerebral arteriovenous malformations: A retrospective case report series. J Neurosurg Anesthesiol 2002; 14: 209-12
    CrossrefPubMedSearch in Google Scholar
  • 14 Ravnik J, Starovasnik B, Ŝeŝok S, Pirtoŝek Z, Ŝvigelj V, Bunc G. et al. Long-term cognitive deficits in patients with good outcomes after aneurysmal subarachnoid hemorrhage from anterior communicating artery. Croat Med J 2006; 47: 253-63
    PubMedSearch in Google Scholar