EEG DSA-guided Intravenous Anesthesia Using Dexmedetomidine and Propofol

Study Overview
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Brief Summary
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Investigators conduct this retrospective analysis to test this hypothesis that the EEG spectrogram guided general anesthesia with dexmedetomidine co-administration with propofol may significantly reduce the propofol consumption during craniotomy and to investigate potential benefits on postoperative outcomes.

Detailed Description
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The bispectral index (BIS), is widely applied to maintain anesthetic depth. However, this processed EEG index may be ambiguous when dexmedetomidine is administrated. Because each anesthetic produces distinct brain states that are readily visible in the EEG spectrogram which can be easily interpreted by anesthesiologists, the EEG spectrogram-guided anesthesia is theoretically beneficial to avoid unnecessary anesthetic exposure when dexmedetomidine is co-administrated but this remains not yet clarified. Recently, the investigators reported a randomized controlled trial which revealed that co-administration of dexmedetomidine with propofol by using the BIS score guidance, is associated with profound propofol sparing effects and more favorable postoperative neurological outcomes (Eur J Anaesthesiol . 2021 Dec 1;38(12):1262-1271.). Based on the advance of knowledge of EEG spectrogram, the investigators have transited our practice based on the EEG spectrogram guidance. In this study, the investigators analyze the influence of EEG spectrogram guidance on the propofol sparing effect and the postoperative profile in comparison to patients of our previous BIS-guided protocol.

Official Title
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Anesthetic Sparing Effects of Dexmedetomidine During Craniotomy: a Retrospective Propensity Score Matching Comparison Between Encephalographic Spectrogram-guided and Processes Encephalographic Index-guided Protocol

Conditions
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Brain Surgery

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients undergoing elective craniotomy for brain tumor resection, aneurysm clipping, an intracranial bypass procedure, or microvascular decompression age between 20 to 80 yr Exclusion Criteria: Fever, elevated white blood cell or C-reactive protein Impaired liver function, eg. AST or ALT >100; liver cirrhosis > Child B class Impaired renal function, cGFR< 60 ml/min/1.73 m2 Cardiac dysfunction, such as heart failure > NYHA class II

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Encephalographic spectrogram group<br>The dexmedetomidine and propofol infusions were titrated to maintain robust alpha power in the encephalographic spectrogram | |
| Encephalographic index group<br>The dexmedetomidine and propofol infusions were titrated to maintain the bispectral index score between 40 and 60. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Propofol dose requirement | Intraoperative propofol consumption | 4-6 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative delirium | Postoperative delirium diagnosed using the Intensive Care Delirium Screening Checklist (ICDSC) criteria | During hospital stay, estimated 7-10 days | 
| Postoperative Barthel index change | Barthel index changes between the states of admission and discharge | During hospital stay, estimated 7-10 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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electroencephalogram, dexmedetomidine, total intravenous anesthesia, craniotomy