Safety and efficacy of dexmedetomidine in neurosurgical patients

Abstract

Primary objective: Very little information regarding effects on ICP, CPP and the safety of dexmedetomidine in neurosurgical patients has been published. The objective of this study is to gather information on the dosage, sedative effects and adverse effects of dexmedetomidine in neurosurgical patients.Research design: The study design was retrospective and descriptive.Methods and procedures: Computerized data were collected from the records of 39 neurosurgical patients in the ICU who received dexmedetomidine between October 2001 and December 2004. MAP, SBP, DBP, HR, ICP and CPP were recorded. The parameter means and standard deviations were obtained and plotted against time.Experimental interventions: Dexmedetomidine, an alpha-2 agonist, provides adequate sedation without altering respiratory drive, while facilitating frequent neurological examinations. The FDA approved a dosage range for a loading infusion of 0.1 mcg kg−1infused over 10 minutes followed by 0.2–0.7 mcg kg−1 h−1continuous infusion for 24 hours.Main outcomes and results: A total of 39 patients were enrolled in the study; 26 men and 13 women. The mean age was 34 years. Of the patients enrolled in the study, 15 were successfully extubated with no adverse reactions while maintaining adequate sedation. Agitation was the predominant adverse reaction. Hypotension occurred in 10 patients. The mean CPP increased and the mean ICP decreased. The standard deviation for the means of the ICP and CPP were small and did not fluctuate as widely as the haemodynamic parameters.Conclusions: Dexmedetomidine can be a safe and effective sedative agent for neurosurgical patients. A loading infusion should be avoided and higher maintenance doses may be required to ensure adequate sedation. Further studies are necessary to establish an optimal dosage regimen.