Comparison of dexmedetomidine and droperidol-fentanyl for asleep-awake-asleep techniques in awake craniotomy anesthesia: a randomized controlled study.

Abstract

Background: In this study, we aimed to compare dexmedetomidine with droperidol-fentanyl during the intraoperative awakening phase of awake craniotomy (AC), focusing on wake-up time.

Methods: We conducted a single-center randomized controlled trial in China from January 2018 to December 2018. Patients aged 36-60 years, with American Society of Anesthesiologists physical status I-II, scheduled for brain glioma resection, were screened for eligibility; 61 were randomized, and 60 were included in the final analysis. The patients were randomized to either the dexmedetomidine group (intravenous loading dose of dexmedetomidine 0.5 µg·kg^- 1 after discontinuation of propofol and remifentanil, followed by a maintenance infusion of dexmedetomidine 0.3-0.5 µg·kg^- 1·h^- 1) or the droperidol-fentanyl group (intravenous loading doses of fentanyl 2 µg·kg^- 1 and droperidol 5 mg after discontinuation of propofol and remifentanil, followed by continuous maintenance infusions of fentanyl 2 µg·kg^- 1·h^- 1 and droperidol 0.1 mg·kg^- 1·h^- 1). A wake-up assessment was performed during maintenance of the assigned study regimen. The primary outcome measure was wake-up time. Secondary outcomes included the Observer's Assessment of Alertness/Sedation (OAA/S) scale, Numerical Rating Scale (NRS), eloquent brain area mapping status, vital signs, and adverse events.

Results: Baseline characteristics were comparable between the groups. Compared with the droperidol-fentanyl group, the dexmedetomidine group had lower mean arterial pressure at T4-T7, lower heart rate at T1-T4 and T7, and a shorter wake-up time, with a between-group difference of 3.5 min (95% CI, 1.95 to 5.05; P < 0.001). No statistically significant differences were detected in OAA/S scores at wake-up (T2), NRS scores, eloquent area mapping status, or adverse events between the groups.

Conclusion: No statistically significant differences were detected in OAA/S scores at wake-up or intraoperative brain mapping performance between the two groups. The dexmedetomidine regimen was associated with a shorter measured wake-up time.

Trial registration: The Chinese Clinical Trial Registry (ChiCTR1800014329) was retrospectively registered on 6 January 2018.