The use of dexmedetomidine infusion for awake craniotomy

Anesthesia for intracranial procedures requiring patient cooperation presen ts a challenge to the anesthesiologist. Drugs administered during the proce dure should provide an adequate level of sedation and analgesia for bone fl ap removal, but must not interfere with functional testing and electrocorti cography. Ln this case report, we describe the use of dexmedetomidine in co mbination with nitrous oxide and sevoflurane for bone flap removal and dexm edetomidine alone for brain mapping of the cortical speech area. Dexmedetom idine is a highly specific ar,adrenoreceptor agonist with sedative, analges ic, and anesthetic-sparing effects (1,2). It does not suppress ventilation. Small-dose infusion of this drug in healthy volunteers provided sedation t hat could be easily reversed with verbal stimuli (3). We anticipated that t he patient treated with dexmedetomidine would be sedated and comfortable bu t easily arousable to tolerate a prolonged awake craniotomy.