Use of Dexmedetomidine Along With Local Infiltration Versus General Anesthesia for Burr Hole and Evacuation of Chronic Subdural Hematoma (CSDH)

Rohini M. Surve, Sonia Bansal, Madhusudan Reddy, Mariamma Philip
2017 Journal of Neurosurgical Anesthesiology  
In neurosurgery, chronic subdural hematoma (CSDH) is a very common clinical entity. Both general anesthesia (GA) and local anesthesia with or without sedation are used for the surgical treatment of CSDH. Sedation with dexmedetomidine has been safely used for various diagnostic and therapeutic procedures. However, its effectiveness against GA has not been evaluated for surgical treatment of CSDH. We tried to compare dexmedetomidine sedation technique with the GA technique for surgical treatment
more » ... f CSDH. Materials and Methods: In this prospective-randomized study, 76 patients undergoing surgery for CSDH were divided into 2 groups using computer-generated randomized tables; Dex group ([n = 38]; received IV bolus of dexmedetomidine 1 mcg/kg over 10 min followed by maintenance infusion 0.5 mcg/kg/h) and GA group ([n = 38; of which 4 patients were dropped out]; received endotracheal intubation with balanced anesthesia). Results: Both anesthesia techniques (Dex group; n = 35/38 [92.1%] and GA group; n = 34/34 [100%]) were successfully used for surgical treatment of CSDH. Significantly less time for anesthesia onset (14.2 ± 4.2 vs. 20.5 ± 3.4 min, P = 0.001), total duration of surgery (77.1 ± 23.9 vs. 102.7 ± 24.8 min, P = 0.001), and recovery from anesthesia (7.4 ± 5.9 vs. 13.2 ± 6.5 min, P = 0.004) was observed in the Dex group compared with GA group. Perioperative hemodynamic fluctuations were more common in the GA group as against the Dex group. Postoperative complications (n = 2 vs. 9, P = 0.021) and length of hospital stay (1.05 ± 0.23 vs. 1.79 ± 2.1 d, P = 0.007) were significantly less in the Dex group as against the GA group. Conclusions: Dexmedetomidine sedation with local anesthesia is a safe and effective technique for burr hole and evacuation of CSDH. It is associated with significantly shorter operative time, lesser hemodynamic fluctuations, postoperative complications, and length of hospital stay, thus it is a better alternative to GA. FIGURE 2. Graph showing changes in the mean heart rate (HR) and mean arterial pressure (MAP) during anesthesia onset (ie, intubation in the general anesthesia [GA] group and loading dose infusion of dexmedetomidine in the Dexmedetomidine group [Dex group]), toward the end of the procedure (ie, extubation in the GA group and cessation of dexmedetomidine infusion in the Dex group), and overall changes during the procedure in both the groups. PE/PA indicates postextubation/postarousal.
doi:10.1097/ana.0000000000000305 pmid:27100913 fatcat:mwzktnyv35fulh32kmwynflkmu