Dexmedetomidine for monitored anesthesia care for sub-dural hematoma evacuation

Abstract

Background & objective: We studied the safety and effectiveness of combination of dexmedetomidine and fentanyl for chronic sub-dural hematoma (CSDH) evacuation. Main objectives of the study was to register the effects on the combination on the cardio-respiratory and analgesic outcome.

Methodology: 56 patients with CSDH were divided into two group. Patients of Group A received dexmedetomidine 1 µg/kg over a period of 10 min with fentanyl 1 µg/kg, followed by an infusion of dexmedetomidine 0.3 µg/kg/min. Group B received fentanyl 1 µg/kg and midazolam 0.03 mg/kg IV. Sedation scores, hemodynamic changes and serial arterial blood gas (ABG) measurements were compared between the two groups.

Results: Heart rate and diastolic blood pressure were significantly lower in Group A compared to Group B throughout the observation period after premedication. Systolic blood pressure readings was significantly lower in Group A compared to Group B from 10 min onwards till the end. ABG analysis showed that Group A had significantly lower PCO₂ levels during and at the end of surgery and significantly higher PO₂ at the end of procedure.

Conclusion: The use of dexmedetomidine is associated with significantly higher PO₂ at the end of the surgical procedure. It results in lower heart rate, systolic and diastolic blood pressures and PCO₂ levels during and at the end of the subdural hematoma evacuation, but the fall remains within the physiological range.