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The Relative Effects of Dexmedetomidine and Propofol on Cerebral Blood Flow and Brain Oxygenation

Podolyak A, Kot M, Machado A, Sessler D, Argalious M, Ebrahim Z, Kurz A, Mascha E, Farag E
Cleveland Clinic, Cleveland, Ohio, United states

Background: Dexmedetomidine is a promising perioperative sedative. However, it can cause cerebral vasoconstriction without a concomitant reduction in cerebral metabolic oxygen consumption, thus potentially compromising safety in patients with neurological diseases. We therefore tested the hypothesis that dexmedetomidine is non-inferior to propofol with regards to cerebral blood flow velocity and brain oxygenation.
Methods: 44 Patients were randomly assigned to either dexmedetomidine or propofol sedation during deep-brain stimulator insertion [Table-1]. Both drugs were given using target-control infusion. Propofol was targeted to a plasma concentration of 2-3 µg/ml and dexmedetomidine to 0.8-1.0 ng/ml. Cerebral blood flow velocity was measured with transcranial Doppler, and brain oxygenation was assessed with infrared spectroscopy.
Results: The relative effects of dexmedetomidine and propofol on cerebral blood flow velocity was 0.94 (90% CI: 0.84, 1.05), P = 0.011]. Similarly, the relative effects of dexmedetomidine and propofol on brain oxygenation was 0.94 (90% CI: 0.84, 1.05, P = 0.011). Both blood flow and oxygenation during dexmedetomidine administration were significantly non-inferior to propofol [Tables 2-3]. Therefore, the effects of dexmedetomidine were similar to those of propofol on cerebral perfusion pressure. However, dexmedetomidine was superior to propofol on observer assessment of alertness and sedation.
Conclusions: The effect of dexmedetomidine is non-inferior to propofol on cerebral blood flow velocity and brain oxygenation during awake deep-brain stimulator insertion.

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