Dexmedetomidine- Ketamine- Midazolam Combinati on for Sedati on in Endovascular Tre atment of Cerebral Arteri o- Veno us Malformati ons and Carotid Artery Stenosis

Czech version

Authors: J. Schreiberová ¹; L. Hess ²; A. Krajina ³; Miroslav Lojík ³
Authors‘ workplace: Klinika anestezi ologi e, resuscitace a intenzivní medicíny LF UK a FN Hradec Králové ¹; Institut klinické a experimentální medicíny Praha, IPVZ Praha ²; Radi ologická klinika LF UK a FN Hradec Králové ³
Published in: Cesk Slov Neurol N 2008; 71/104(4): 446-452
Category: Original Paper

Studie byla podpořena grantem IGA MZ ČR č. NR 8508-3

Overview

Backgro und:
Immobility, analgesi a, anxi olysis, amnesi a, preserved pati ent co operati on and hemodynamic stability witho ut respiratory depressi on are the requirements for sedati on in endovascular tre atment of cerebral arteri oveno us malformati ons and carotid artery stenting. The go al of o ur study was to assess dexmedetomidine- ketamine- midazolam sedati on for this use and compare it with ro utine sufentanil- midazolam sedati on.

Methods:
62 pati ents undergo ing elective endovascular ne uro- interventi ons were randomly divided into two gro ups for sedati on. Gro up A: intraveno us bolus applicati on of dexmedetomidine 0.5 µg/ kg, ketamine 0.25 mg/ kg and midazolam 0.02 mg/ kg during five minutes followed by infusi on of dexmedetomidine 0.25 µg/ kg/ h and ketamine 0.25 mg/ kg/ h. Gro up B: bolus applicati on of sufentanil 10 µg and midazolam 0.02 mg/ kg. Sedati on was then titrated to keep the pati ent sedated, but responsive to vocal commands. Parameters which were monitored: blo od pressure, ECG, haemoglobin saturati on, respiratory rate, arteri al carbon di oxide tensi on, depth of sedati on, side effects, complicati ons and recovery. Pati ent co operati on (excellent- suffici ent- po or) was assessed by the radi ologist, who was blind to the method used. Statistical analysis: t- test, χ² test, ANOVA.

Results:
Decre ases of blo od pressure and he art rate were significantly more marked in gro up A (p < 0.001), tho ugh the number of episodes of hypotensi on or bradycardi a did not differ significantly. Vari ability of blo od pressure within individu al pati ents was lower in gro up A (p < 0.05). Co operati on was better in gro up A (p < 0.001). No other statistically significant differences were fo und. No clinically significant complicati ons were recorded.

Conclusi on:
Sedati on by dexmedetomidine-ketamin- midazolam combinati on seems to be a safe and suitable method for endovascular ne uro- interventi ons. It secures very go od co operati on with the pati ent and hemodynamic stability witho ut respiratory depressi on.

Key words:
endovascular ne uro- interventi ons – sedati on – dexmedetomidine- ketamine- midazolam combinati on

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