Dexmedetomidine related apnea and desaturation during awake craniotomy: a case report

Abstract

Dexmedetomidine (Dex) is regarded as a novel sedative agent since the drug preserves respiration and makes ‘conscious sedation’ possible. This drug is widely used for monitored anesthesia care (MAC). We report a case of apnea and desaturation in awake craniotomy surgery under MAC after loading of Dex with 1 mg/kg over 10 min and discuss possible explanations. We advocate using Dex with a lower loading dose over a prolonged duration and the up-titration of the drug according to the patient’s response particularly in those who are underweight or elderly. Meticulous judgement for possible interactions of Dex with antiepileptics, opioids and other sedative agents is essential during MAC. Abbreviations: BIS- Bispectral Index; Dex- Dexmedetomidine; DBS- Deep Brain Stimulation; MAC- Monitored Anesthesia Care; TCI- Targeted-Controlled Infusion Key words: Dexmedetomidine; Craniotomy; Apnea; Conscious sedation; Balanced anesthesia; Anticonvulsant Citation: Hasyizan HM, Mohd Nazaruddin WHWM, Laila AM, Zamzuri I, Zulfakar MM. Dexmedetomidine related apnea and desaturation during awake craniotomy: a case report. Anaesth. pain intensive care 2023;27(4):609−612; DOI: 10.35975/apic.v27i4.1901 Received: May 30, 2022; Reviewed: December 28, 2022; Accepted: May 22, 2023