J Korean Neurosurg Soc.  2014 Apr;55(4):185-189. 10.3340/jkns.2014.55.4.185.

Usefulness of Dexmedetomidine during Intracerebral Aneurysm Coiling

• Lee HH
• Jung YJ
• Choi BY
• Chang CH

• KMID: 2191089
• DOI: http://doi.org/10.3340/jkns.2014.55.4.185

Abstract

OBJECTIVE
General anesthesia is often preferred for endovascular coiling of intracranial aneurysm at most centers. But in the authors' hospital, it is performed under monitored anesthesia care (MAC) using dexmedetomidine. To determine the feasibility and safety of this approach, the authors reviewed our initial experience.
METHODS
Retrospective data was analyzed from July 2012 to November 2012. We performed coil embolization in 28 cases using this method. Among them, for statistical significance, we analyzed 12 cases in which the procedure time exceeded an hour. Vital signs were analyzed every 10 minutes. Depth of sedation was measured according to the Ramsay sedation scale and frequency of the repeated roadmap image(s) caused by movement of the patient's head during the procedure.
RESULTS
All procedures were completed without occurrence of procedure related complications. Under MAC using dexmedetomidine, vital signs of the patients were stable, no statistical significance regarding hemodynamic and respiratory parameters was observed between time points (p>0.05). Adequate sedation was achieved. Mean Ramsay sedation scale was 3.67+/-1.61 (2 to 6). Repeated roadmap image(s) due to patient's factor occurred in only one case. The mean dosage of drug for adequate sedation for the procedure was 0.65+/-0.12 mcg/kg/hr without loading doses.
CONCLUSION
To the best of my knowledge, this is the first report published in English using the method of monitored anesthesia with dexmedetomidine for intracranial aneurysm coiling. Monitored anesthesia care using dexmedetomidine without loading dose for embolization of intracranial aneurysms appeared to be a safe and effective alternative to general anesthesia.

Keyword

Dexmedetomidine; Aneurysm; Coiling

MeSH Terms

Anesthesia
Anesthesia, General
Aneurysm*
Dexmedetomidine*
Embolization, Therapeutic
Head
Hemodynamics
Humans
Intracranial Aneurysm
Retrospective Studies
Vital Signs
Dexmedetomidine

Figure

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  Fig. 1 Change of hemodynamic variable (SBP, DBP) according to procedure time. Systolic and diastolic blood pressure of the patients did not change during periods of dexmedetomidine infusion and it did not show statistical significance (p>0.05). SBP : systolic blood pressure, DBP : diastolic blood pressure.

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  Fig. 2 Change of hemodynamic variable (mABP) according procedure time. The mABP of the patients did not change during periods of dexmedetomidine infusion and it also did not show statistical significance (p>0.05). mABP : mean arterial blood pressure.

• 

  Fig. 3 Change of respiratory variables (HR, RR, SpO2) according to procedure time. HR, RR, and SpO2 of the patients did not change during periods of dexmedetomidine infusion and it did not show statistical significance (p>0.05). HR : heart rate, RR : respiratory rate, SpO2 : peripheral oxygen saturation.

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