COMPARISON OF PROPOFOL/DEXMEDETOMIDINE FOR ASLEEP AWAKE ASLEEP TECHNIQUE FOR AWAKE CRANIOTOMIES IN TERTIARY CARE HOSPITAL.

Corresponding Author:
Dr. Manisha S. Kapdi,
Associate Professor,
Department of Anaesthesia,
NHLM Medical College,
Ahmedabad, Gujarat, India.
E-mail: manisha_kapdi@yahoo.com

ABSTRACT

BACKGROUND

Awake craniotomy is an important technique used for brain tumour excision from eloquent cortex, epilepsy foci removal surgery, deep brain stimulation, less commonly for mycotic aneurysms, A-V malformation near cortical areas.

Aims and Objectives- To access quality of brain mapping, haemodynamic stability, perioperative airway security, & observation of adverse effects in propofol, dexmedetomidine groups for awake craniotomies.

Group Allocation- (Maintenance of anaesthesia in both groups was different as follows :)

Group A (Propofol Group): inj. propofol 6 mg/kg/hour for 10 min, then 4 mg/kg/hour. (n=25)

Group B (Dexmedetomidine group): Inj. dexmedetomidine 0.5 mg/kg/hour (n=25).

MATERIALS & METHODS

This randomised double-blind comparative study of premedication- Inj. glycopyrrolate 0.04 mg/kg, inj. ondansetron 0.08 mg/kg & in fentanyl 1 mcg/kg. Scalp block: scalp block was given with inj. Ropivacaine 0.5% 30 ml to block supraorbital, supratrochlear, zygomatic temporal, auriculotemporal nerves, greater auricular, lesser auricular nerves in General Hospital, NHLM medical college, Ahmedabad, Gujarat, India.

Induction- Induction was done with inj. thiopentone 5 to 7 mg/kg IV.

Airway security- By i-gel (second generation laryngeal mask airway)

Maintenance-

In group A: inj. propofol 6 mg/kg/hour for first 10 min then 4 mg/kg/hour

In group B: inj. dexmedetomidine 1 mcg/kg/hour for first 10 min then 0.5 mcg/kg/hour

When neurosurgeon wanted to perform brain mapping, patient's i-gel was removed & patients were managed with low dose of propofol & dexmedetomidine in awake period, then further dose was increased in 3rd phase, that is asleep period.

RESULTS

NRS score of cortical mapping was comparable in both groups-

• In both groups haemodynamic variables were stable & comparable.
• In group B better airway management & less complications observed.

CONCLUSION

In AAA method for awake craniotomies, use of dexmedetomidine is a good alternative to propofol.

KEYWORDS

Awake Craniotomy, AAA Method, Dexmedetomidine, Propofol, i-gel, Scalp Block.