Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
View/Download PDF

Translate this page into:

Editorial
5 (
Suppl 1
); S1-S2
doi:
10.4103/0976-3147.145190

Hemodynamic effects of dexmedetomidine during intra-operative electrocorticography for epilepsy surgery

Division of Pediatric Neurosurgery, Norton Neuroscience Institute, Louisville, Kentucky, USA
Address for correspondence: Dr. William C. Gump, Norton Neuroscience Institute, 210 East Gray Street, Suite 1102, Louisville, Kentucky - 40202, USA. E-mail: william.gump@nortonhealthcare.org
Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Disclaimer:
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.

The dominant challenge in epilepsy surgery is precise delineation of the epileptogenic zone in the brain. Noninvasive techniques such as video electroencephalography (EEG), single photon emission computerized tomography (SPECT), positron emission tomography (PET), magnetoencephalography (MEG), and high-resolution MRI all lack sufficient spatial resolution and sensitivity in many patients. Extraoperative seizure mapping with subdural and/or depth electrodes can be appropriate in many cases, but is not without significant drawbacks. Disadvantages include the requirement for more than one major intracranial operation, need for the patient to be reasonably compliant, insufficient seizure capture, and potential surgical complications including hemorrhage and infection. In addition, electrode coverage may not be adequate, and areas such as insular and frontobasal cortex can be technically challenging to access. Intraoperative electrocorticography (ECoG) avoids many of these disadvantages (notably aside from inadequate coverage), but at the expense of capturing only interictal EEG data. The quality of intraoperative EEG data, therefore, is of paramount importance during one-stage epilepsy surgeries in which ECoG is employed.

Dexmedetomidine is an intravenous alpha 2-adrenergic receptor agonist whose use in neurological surgery has blossomed over the past several years due to its sedation properties and desirable neurophysiological profile.[1] This medication has been extensively studied in the context of various neurosurgical pathologies and treatment modalities including awake brain tumor surgery, functional MRI scanning, and endovascular aneurysm treatment.[234] Its use has also been studied with electroconvulsive therapy, where postprocedural agitation was found to be improved but induced seizure duration not apparently altered.[56]

The primary concerns regarding dexmedetomidine use in epilepsy surgery revolve around two issues, alteration of the EEG profile and hemodynamic effects, particularly bradycardia and hypotension. Dexmedetomidine does not seem to be a significant EEG confounder.[7] Its intraoperative hemodynamic profile also seems to be safe, although this particular aspect has not previously been specifically addressed within the context of epilepsy surgery.[8] The present study addresses this concern directly with a series of patients undergoing ECoG-guided anterior temporal lobectomy and amygdalohippocampectomy, the most common resective surgery for epilepsy in the adult population.[9] The findings are that dexmedetomidine anesthesia does generate a measurable but clinically insignificant hemodynamic effect when used in this context, and that it does not otherwise adversely impact surgery. This study is a useful contribution to the body of data on which the practice of epilepsy surgery is based. Further studies such as this will allow epilepsy surgery to continue to become more safe and more efficacious.

Source of Support: Nil.

Conflict of Interest: None declared.

References

  1. , , . Dexmedetomidine for neurological surgery. Neurosurgery. 2005;57(Suppl 1):1-10.
    [Google Scholar]
  2. , , , , , , . Comparison of dexmedetomidine and propofol for conscious sedation in awake craniotomy: A prospective, double-blind, randomized, and controlled clinical trial. Ann Pharmacother. 2013;47:1391-9.
    [Google Scholar]
  3. , , , , . FMRI under sedation: What is the best choice in children? J Clin Med Res. 2012;4:363-70.
    [Google Scholar]
  4. , , , , . Usefulness of dexmedetomidine during intracerebral aneurysm coiling. J Korean Neurosurg Soc. 2014;55:185-9.
    [Google Scholar]
  5. , , , , , . Premedication with dexmedetomidine and midazolam attenuates agitation after electroconvulsive therapy. J Anesth. 2009;23:6-10.
    [Google Scholar]
  6. , , , , , , . Dexmedetomidine blunts acute hyperdynamic responses to electroconvulsive therapy without altering seizure duration. Acta Anaesthesiol Scand. 2008;52:302-6.
    [Google Scholar]
  7. , , , , . Effects of dexmedetomidine sedation on the EEG in children. Paediatr Anaesth. 2009;19:1175-83.
    [Google Scholar]
  8. , , , , , , . The effect of dexmedetomidine on perioperative hemodynamics in patients undergoing craniotomy. Anesth Analg. 2008;107:1340-7.
    [Google Scholar]
  9. , , , , , , . Hemodynamic effects of Dexmedetomidine during intra-operative electrocorticography for epilepsy surgery. J Neurosci Rural Pract. 2014;5:S17-21.
    [Google Scholar]

    Fulltext Views
    214

    PDF downloads
    219
    View/Download PDF
    Download Citations
    BibTeX
    RIS
    Show Sections