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NEUROSURGICAL ANESTHESIA

Dexmedetomidine Does Not Increase the Incidence of Intracarotid Shunting in Patients Undergoing Awake Carotid Endarterectomy

Alex Bekker, MD, PhD^*, Mark Gold, MD^*, Raza Ahmed, MD^*, Jung Kim, MD^*, Caron Rockman, MD, Glenn Jacobovitz, MD, Thomas Riles, MD, and Gene Fisch, PhD

From the Departments of *Anesthesiology and Surgery, New York University Medical Center, New York, New York; and Department of Applied Sciences, Yeshiva University, New York, New York.

Address correspondence and reprint requests to Alex Bekker MD, PhD, Associate Professor of Anesthesiology and Neurosurgery, Chief of Neuroanesthesia, 560 First Ave., New York, NY, 10016. Address e-mail to alex.bekker{at}med.nyu.edu.

Systemic administration of dexmedetomidine (DEX) decreases cerebral bloodflow (CBF) via direct -2-mediated constriction of cerebral blood vessels and indirectly via its effect on the intrinsic neural pathway modulating vascular smooth muscle. Reduction in CBF without a concomitant decrease in cerebral metabolic rate has raised concerns that DEX may limit adequate cerebral oxygenation of brain tissue in patients with already compromised cerebral circulation (e.g., carotid endarterectomy [CEA]). In this study, we established the incidence of intraarterial shunting used as a sign of inadequate oxygen delivery in a consecutive series of 123 awake CEA performed in our institution using DEX as a primary sedative. Data were prospectively recorded in 151 patients who underwent CEA during the study period. Eighteen patients were sedated with midazolam and fentanyl (M/F) for medical or logistical reasons. Patients thought to be at risk of an intraoperative stroke were treated with a prophylactic intraarterial shunt. These patients, as well as those who required general anesthesia, were excluded from the final analysis. Five patients (4.3%) in the DEX group required intraarterial shunts. The incidence of shunting in patient undergoing awake CEA in our institution is 10% (historical control). No patients developed a stroke or other serious complications. It appears that the use of DEX as a primary sedative drug for CEA does not increase the incidence of intraarterial shunts.

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