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Purpose <p>Monitored anesthesia care (MAC) with continuous sedation for awake craniotomy allows rapid recovery but increases risks of hypoventilation and hypoxemia. In April 2019, our center replaced propofol-based sedation with dexmedetomidine-based protocols to improve respiratory safety. We evaluated the impact of this protocol change on respiratory and hemodynamic outcomes.</p> Methods <p>This single-center retrospective before-after observational study analyzed all adult patients undergoing awake craniotomy between April 2017 and July 2021. The propofol group (April 2017-March 2019) received propofol-remifentanil sedation; the dexmedetomidine group (April 2019-July 2021) received dexmedetomidine-based sedation with supplemental low-dose propofol. Primary endpoints were hypoxemia (SpO2 &lt; 92%) and hypercarbia (PaCO2 and transcutaneous PCO2). Secondary endpoints included hemodynamic stability and adverse events.</p> Results <p>We included 103 patients (51 propofol, 52 dexmedetomidine). Desaturation below 92% occurred more frequently in the propofol group (40% vs. 17%, <i>p</i> = 0.04). PaCO2 levels were significantly lower with dexmedetomidine across all sedation periods (period 1: 52 ± 0.9 vs. 64 ± 2&#xa0;mmHg, <i>p</i> &lt; 0.0001; period 2: 52 ± 1 vs. 66 ± 2&#xa0;mmHg, <i>p</i> = 0.0002; period 4: 48 ± 0.8 vs. 51 ± 1&#xa0;mmHg, <i>p</i> = 0.03). Mean arterial pressure was higher and less variable in the dexmedetomidine group (<i>p</i> &lt; 0.01). Blood loss exceeding 500&#xa0;mL was more common with propofol (41% vs. 19%, <i>p</i> = 0.027). Mapping conditions were excellent in both groups (96%).</p> Conclusions <p>In this single-center retrospective study, transitioning from propofol-based to dexmedetomidine-based sedation for awake craniotomy was associated with improved respiratory and hemodynamic safety.</p>

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Dexmedetomidine versus propofol for sedation in awake neurosurgery: respiratory and hemodynamic safety

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月3日

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  • Charlotte Levé,
  • Fabrice Vallée,
  • Sylvie Aubrun,
  • Séverine Levavasseur,
  • Mickael Rajaona,
  • Kanssaa El Ayeb,
  • Emmanuel Mandonnet,
  • Cyril Touchard,
  • Joaquim Mateo,
  • Jérôme Cartailler,
  • Jona Joachim

摘要

Purpose

Monitored anesthesia care (MAC) with continuous sedation for awake craniotomy allows rapid recovery but increases risks of hypoventilation and hypoxemia. In April 2019, our center replaced propofol-based sedation with dexmedetomidine-based protocols to improve respiratory safety. We evaluated the impact of this protocol change on respiratory and hemodynamic outcomes.

Methods

This single-center retrospective before-after observational study analyzed all adult patients undergoing awake craniotomy between April 2017 and July 2021. The propofol group (April 2017-March 2019) received propofol-remifentanil sedation; the dexmedetomidine group (April 2019-July 2021) received dexmedetomidine-based sedation with supplemental low-dose propofol. Primary endpoints were hypoxemia (SpO2 < 92%) and hypercarbia (PaCO2 and transcutaneous PCO2). Secondary endpoints included hemodynamic stability and adverse events.

Results

We included 103 patients (51 propofol, 52 dexmedetomidine). Desaturation below 92% occurred more frequently in the propofol group (40% vs. 17%, p = 0.04). PaCO2 levels were significantly lower with dexmedetomidine across all sedation periods (period 1: 52 ± 0.9 vs. 64 ± 2 mmHg, p < 0.0001; period 2: 52 ± 1 vs. 66 ± 2 mmHg, p = 0.0002; period 4: 48 ± 0.8 vs. 51 ± 1 mmHg, p = 0.03). Mean arterial pressure was higher and less variable in the dexmedetomidine group (p < 0.01). Blood loss exceeding 500 mL was more common with propofol (41% vs. 19%, p = 0.027). Mapping conditions were excellent in both groups (96%).

Conclusions

In this single-center retrospective study, transitioning from propofol-based to dexmedetomidine-based sedation for awake craniotomy was associated with improved respiratory and hemodynamic safety.