Effect of dexmedetomidine as a sedative in sub-dural hematoma evacuation surgeries

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.