Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Apr 2004
Randomized Controlled Trial Clinical TrialDexmedetomidine for awake carotid endarterectomy: efficacy, hemodynamic profile, and side effects.
: A randomized, double-masked, placebo-controlled study was designed to compare dexmedetomidine as a primary sedative agent with a commonly used drug combination in patients undergoing awake carotid endarterectomy (CEA). Sixty-six patients undergoing CEA (ASA II-IV) were randomly assigned to receive either dexmedetomidine (total dose of 97.5 +/- 54.7 mcg) or normal saline (control). Supplemental doses of midazolam, fentanyl, and/or propofol were administered as deemed necessary by the anesthesiologist. ⋯ These data show that the use of dexmedetomidine in patients undergoing awake CEA resulted in fewer fluctuations from the desired sedation level. Patients receiving dexmedetomidine required less antihypertensive therapy compared with the midazolam/fentanyl/propofol combination. The effect of dexmedetomidine on cerebrovascular circulation in the study population needs further investigation.
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J Neurosurg Anesthesiol · Apr 2004
Randomized Controlled Trial Clinical TrialJet injection of local anesthetic decreases pain of arterial cannulation in awake neurosurgical patients.
Arterial cannulation through the standard skin wheal of local anesthetic raised with a needle may be painful. The authors compared the efficacy of local anesthetic injected via a 25G needle versus a Bioject jet injector for arterial cannulation in awake neurosurgical patients. After institutional review board approval, 40 patients were randomized to receive 0.3 mL 1% lidocaine adjusted to pH 7.0 with NaHCO3 by Bioject with a 2-cm spacer between the syringe and skin or by 25G needle injection. ⋯ Median observer scores at injection and cannulation were 1 (range 0-2) for the needle group and 0 (range 0-2) for the Bioject group (P < 0.001). Patients in the Bioject group experienced significantly less pain during lidocaine administration and at the time of arterial cannulation by their own and by an observer's assessment than the needle injection group. Jet injection of local anesthetic should be considered prior to arterial cannulation in awake patients.