Dexmedetomidine versus propofol for sedation in stereotactic brain biopsy: a comparative study

Background
The aim of this study was to assess the effectiveness of intraoperative dexmedetomidine versus propofol infusions on the sedation and the recovery profiles during stereotactic brain biopsy. A total of 40 patients of American Society of Anesthesiologists (ASA) physical status II were randomly divided to receive either dexmedetomidine hydrochloride (group D) or propofol (group P). The time to reach Ramsay sedation scale of 2–4, as well as the recovery profile by the modified Aldrete score, was recorded.
Results
The heart rate (HR) in group D was significantly lower than that in group P, starting from 2 min after the loading doses and during the whole painful steps of the procedure. The systolic blood pressure (SBP) showed a statistically non-significant decrease over time in both groups except at 2 min after the loading dose in group D, when it was significantly lower than the baseline value. The diastolic blood pressure (DBP) showed a statistically significant decrease over time in group D, starting from 2 min after the loading dose and with skin incision, during burr-hole drilling of the skull and with the dural stitch. The decrease in respiratory rate (RR) recorded 2 min after the loading dose in group P was statistically non-significant to the baseline value; it resulted in a statistically significant decrease in the arterial oxygen saturation (SpO) and statistically significant higher end tidal carbon dioxide (etCO) values that continued till the skin incision. As regards the time to reach Ramsay sedation scale (RSS) of 2–4 and a modified Aldrete score of ≥ 9, they were statistically but not clinically significantly less in group P. However, the time till the first request of analgesia was statistically and clinically significantly more in group D.
Conclusion
Dexmedetomidine offers rapid onset and recovery of sedation, as well as hemodynamic stability with post-operative analgesic effect during day-case stereotactic brain biopsy surgery.