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2019 Month : January Volume : 8 Issue : 1 Page : 14-18COMPARISON OF PROPOFOL/DEXMEDETOMIDINE FOR ASLEEP AWAKE ASLEEP TECHNIQUE FOR AWAKE CRANIOTOMIES IN TERTIARY CARE HOSPITAL.
Manisha S. Kapdi1, Rupal J. Shah2, Shvangi Patel3, Manhar G. Vachhani4, Nidhi Patel5
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.