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Performing real time neuropsychological testing during awake craniotomy: are dexmedetomidine or propofol the same? A preliminary report

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Abstract

Purpose

In awake surgery, the patient is sedated, but is also required to be sufficiently alert and collaborative during extensive neurocognitive testing. In the present preliminary report of a retrospective single-center study, a continuous series of 168 patients who underwent awake surgery for brain tumor located near eloquent areas, was investigated to observe the effect of dexmedetomidine (n = 58) compared with propofol (n = 110) on vigilance and collaboration required to perform extensive intra-operatory Real Time Neuropsychological Testing (RTNT).

Methods

We assigned a score to each patient, by using a scale that combines vigilance and collaboration in a 5 levels score (the higher score denoting higher level).

Results

The median interquartile range was significantly lower (range 3–5) for the dexmedetomidine group compared to the propofol one (range 4–5, p = .044). Patients with intra-operative seizures (p = .014) and/or electrocorticographic slow/epileptiform activity (p = .042), and patients in the propofol group who showed increased heart rate (p = .032) were those who obtained the lower scores (lower vigilance and collaboration level).

Conclusion

The study shows that the effect of dexmedetomidine or propofol -based conscious sedation on ability to perform Real Time Neuropsychological Testing during awake surgery for supratentorial tumor resection is different. Although both permit high mean levels of vigilance and collaboration, the patient who received dexmedetomidine was more likely to show lower vigilance and collaboration during RTNT.

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Data availability

The datasets analyzed for this study will be made available from the authors upon request.

Abbreviations

Cet:

Concentration at effect site

DES:

Direct electrical stimulation

DEX:

Dexmedetomidine

ECoG:

Electrocorticography

EEG:

Electroencephalogram

IOS:

Intra-operative seizure

HFF:

High frequency filter

LFF:

Low frequency filter

MRI:

Magnetic resonance imaging

P:

Propofol

R:

Remifentanil

RTNT:

Real time neuropsychological testing

TCI:

Target controlled infusion

V/C:

Vigilance and collaboration

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Acknowledgements

This work was supported by the Ricerca Corrente (Italian Ministry of Health) to B.T.

Funding

This study was funded by Ministry of Health, Ricerca Corrente.

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Authors and Affiliations

  1. Scientific Institute IRCCS “Eugenio Medea”, Polo FVG, San Vito Al Tagliamento, PN, Italy

    Barbara Tomasino & Ilaria Guarracino

  2. Department of Neurological Sciences, Health Integrated Agency of Friuli Centrale, Academic Hospital of Udine, Piazzale S. M. Della Misericordia 15, 33100, Udine, Italy

    Giada Pauletto, Tamara Ius, Annacarmen Nilo, Lorenzo Verriello, Christian Lettieri, Gian Luigi Gigli & Mariarosaria Valente

  3. Neurology, Department of Medicine (DAME), University of Udine, 33100, Udine, Italy

    Sara Pez, Gian Luigi Gigli, Mariarosaria Valente & Miran Skrap

  4. Operative Unit of Neurosurgery, Department of NESMOS, Sapienza University of Rome, Rome, Italy

    Tamara Ius

  5. Department of Medicine (DAME), University of Udine, 33100, Udine, Italy

    Davide Furlan, Miriam Isola & Maria De Martino

  6. Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Academic Hospital of Udine, Piazzale S. M. Della Misericordia 15, 33100, Udine, Italy

    Stefano Mauro & Cristian Deana

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  1. Barbara Tomasino
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Contributions

GP, TI, MS, CD and BT designed the study, GP, SP, IG, TI, DF, AN, SM, CL, acquired the data; MI, MDM and BT analyzed the data; BT, GP, IG, TI, CD and MS wrote the paper; all authors edited the paper; all authors revised the final version of the manuscript.

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Correspondence to Barbara Tomasino or Cristian Deana.

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Tomasino, B., Guarracino, I., Pauletto, G. et al. Performing real time neuropsychological testing during awake craniotomy: are dexmedetomidine or propofol the same? A preliminary report. J Neurooncol 160, 707–716 (2022). https://doi.org/10.1007/s11060-022-04191-5

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