Comparative effects of propofol and dexmedetomidine on cerebral hemodynamics in intracranial surgery

M. Rayhan Reza Rony; Mohammed Mohidur Rahman; Tanjila Rahman Tannee; M. Rabiul Islam; Jannath Ara Ferdous; Dawan Mohammad Anisur Rahman; M. Anwarul Mamun

doi:10.18203/2320-6012.ijrms20260597

Authors

M. Rayhan Reza Rony Department of Neuro-Anaesthesia, National Institute of Neurosciences and Hospital (NINS), Dhaka, Bangladesh
Mohammed Mohidur Rahman Department of Neuro-Anaesthesia, National Institute of Neurosciences and Hospital (NINS), Dhaka, Bangladesh
Tanjila Rahman Tannee Department of Neuro-Anaesthesia, National Institute of Neurosciences and Hospital (NINS), Dhaka, Bangladesh
M. Rabiul Islam Department of Neuro-Anaesthesia, National Institute of Neurosciences and Hospital (NINS), Dhaka, Bangladesh
Jannath Ara Ferdous Department of Anaesthesia, Analgesia and ICU, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh
Dawan Mohammad Anisur Rahman Department of Anaesthesia, ICU, Pain Medicine and Palliative Care, Dhaka Medical College and Hospital, Dhaka, Bangladesh
M. Anwarul Mamun Department of Neuro-Anaesthesia, National Institute of Neurosciences and Hospital (NINS), Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2320-6012.ijrms20260597

Keywords:

Dexmedetomidine, Propofol, Cerebral hemodynamics, Intracranial pressure, Cerebral perfusion pressure

Abstract

Background: Maintaining stable cerebral hemodynamics is essential during intracranial surgery to ensure adequate perfusion and minimize secondary injury. This study compared the effects of propofol and dexmedetomidine on cerebral and systemic hemodynamics in patients undergoing elective intracranial surgery.

Methods: In this prospective observational study, 95 adult patients were allocated into two maintenance anesthesia groups: propofol (n=48) and dexmedetomidine (n=47). Intraoperative parameters including mean arterial pressure (MAP), heart rate (HR), intracranial pressure (ICP), cerebral perfusion pressure (CPP), and regional cerebral oxygen saturation (rSO₂) were recorded at defined intervals. Brain relaxation was assessed at dural opening using a four-point scale. Postoperative recovery and complications were evaluated over 30 days.

Results: Dexmedetomidine produced higher mean CPP (75.6±5.8 versus 72.3±6.5 mmHg, p=0.010), lower ICP (15.9±3.8 versus 18.1±4.7 mmHg, p=0.015), and higher rSO₂ (77.5±6.3 versus 73.2±7.1%, p=0.003) compared to Propofol. Bradycardia occurred more often with Dexmedetomidine (29.8% versus 12.5%, p=0.035), while hypotension was more frequent with Propofol (41.7% versus 25.5%, p=0.096). Dexmedetomidine was an independent predictor of good brain relaxation (OR 3.46, p=0.015), along with adequate CPP (OR 5.37, p=0.003). ROC analysis identified CPP as the best predictor of optimal brain relaxation (AUC=0.86).

Conclusions: Dexmedetomidine offers superior cerebral perfusion and hemodynamic stability over propofol during intracranial surgery without increasing adverse events.

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References

Czosnyka M, Miller C. Monitoring of Cerebral Autoregulation. Neurocrit Care. 2014;21(2):95-102. DOI: https://doi.org/10.1007/s12028-014-0046-0

Svedung Wettervik T, Howells T, Lewén A, Ronne-Engström E, Enblad P. Temporal Dynamics of ICP, CPP, PRx, and CPPopt in High-Grade Aneurysmal Subarachnoid Hemorrhage and the Relation to Clinical Outcome. Neurocrit Care. 2021;34(2):390-402. DOI: https://doi.org/10.1007/s12028-020-01162-4

Cucciolini G, Motroni V, Czosnyka M. Intracranial pressure for clinicians: it is not just a number. J Anesth Analg Crit Care. 2023;3(1):31. DOI: https://doi.org/10.1186/s44158-023-00115-5

Czosnyka M, Pickard JD, Steiner LA. Principles of intracranial pressure monitoring and treatment. Handb Clin Neurol. 2017;140:67-89. DOI: https://doi.org/10.1016/B978-0-444-63600-3.00005-2

Giulioni M, Ursino M. Impact of cerebral perfusion pressure and autoregulation on intracranial dynamics: a modeling study. Neurosurgery. 1996;39(5):1005-14. DOI: https://doi.org/10.1227/00006123-199611000-00024

Liu Z, Song S. Effects of Anesthetics on the Central Nervous System. In: Liu Z, Song S, editors. Neuroscience of Anesthesia: From Cellular Mechanisms to Clinical Applications. Cham: Springer Nature Switzerland. 2025: 63-86. DOI: https://doi.org/10.1007/978-3-031-85156-8_7

Slupe AM, Kirsch JR. Effects of anesthesia on cerebral blood flow, metabolism, and neuroprotection. J Cereb Blood Flow Metab. 2018;38(12):2192-208. DOI: https://doi.org/10.1177/0271678X18789273

John S, Somal J, Thebo U, Hussain MS, Farag E, Dupler S, et al. Safety and Hemodynamic Profile of Propofol and Dexmedetomidine Anesthesia during Intra-arterial Acute Stroke Therapy. J Stroke Cerebrovasc Dis. 2015;24(10):2397-403. DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.06.041

Hou Y, Ye W, Tang Z, Li F. Anesthetics in pathological cerebrovascular conditions. J Cereb Blood Flow Metab. 2025;45(1):32-47. DOI: https://doi.org/10.1177/0271678X241295857

Mikkelsen MLG, Ambrus R, Rasmussen R, Miles JE, Poulsen HH, Moltke FB, et al. The effect of dexmedetomidine on cerebral perfusion and oxygenation in healthy piglets with normal and lowered blood pressure anaesthetized with propofol-remifentanil total intravenous anaesthesia. Acta Vet Scand. 2017;59(1):27. DOI: https://doi.org/10.1186/s13028-017-0293-0

Li YC, Wang R, A JY, Sun RB, Na SJ, Liu T, et al. Cerebrospinal fluid metabolic profiling reveals divergent modulation of pentose phosphate pathway by midazolam, propofol and dexmedetomidine in patients with subarachnoid hemorrhage: a cohort study. BMC Anesthesiol. 2022;22(1):34. DOI: https://doi.org/10.1186/s12871-022-01574-z

Srivastava VK, Agrawal S, Kumar S, Mishra A, Sharma S, Kumar R. Comparison of dexmedetomidine, propofol and midazolam for short-term sedation in postoperatively mechanically ventilated neurosurgical patients. J Clin Diagn Res. 2014;8(9):GC04-07. DOI: https://doi.org/10.7860/JCDR/2014/8797.4817

Khallaf M, Thabet AM, Ali M, Sharkawy E, Abdel-rehim S. The effect of dexmedetomidine versus propofol in traumatic brain injury: evaluation of some hemodynamic and intracranial pressure changes. Egyptian Journal of Neurosurgery. 2019;34(1):17. DOI: https://doi.org/10.1186/s41984-019-0041-z

Thakkar K, Mariappan R, Prabhu K, Yadav B, Singh G. Comparison of Monitored Anesthesia Care with Propofol Versus Dexmedetomidine for Awake Craniotomy: A Retrospective study. J Neuroanaesth Crit Care [Internet]. 2023;10(02):087-93.

Owusu KA, Kurczewski L, Armahizer MJ, Zichichi A, Maciel CB, Heavner MS. DEXmedetomidine compared to PROpofol in NEurocritical Care [DEXPRONE]: A multicenter retrospective evaluation of clinical utility and safety. J Crit Care. 2020;60:79-83. DOI: https://doi.org/10.1016/j.jcrc.2020.07.021

Viderman D, Nabidollayeva F, Bilotta F, Abdildin YG. Comparison of dexmedetomidine and propofol for sedation in awake craniotomy: A meta-analysis. Clin Neurol Neurosurg. 2023;226:107623. DOI: https://doi.org/10.1016/j.clineuro.2023.107623

Iqbal J, Naseem A, Bashir MA, Yangi K, Bozkurt I, Chaurasia B. Global perspective of neurosurgery practice in lower middle-income countries: challenges, opportunities, and the path forward. Ann Med Sur. 2025;87(5):2532. DOI: https://doi.org/10.1097/MS9.0000000000003221

Ajoku U, Hawryluk G, Kullmann M. Intracranial pressure monitoring and treatment practices in severe traumatic brain injury between low-and middle-income countries and high-income countries: Data or dogma? Surg Neurol Int. 2024;15:368. DOI: https://doi.org/10.25259/SNI_251_2024

Wood MD, Boyd JG, Wood N, Frank J, Girard TD, Ross-White A, et al. The Use of Near-Infrared Spectroscopy and/or Transcranial Doppler as Non-Invasive Markers of Cerebral Perfusion in Adult Sepsis Patients With Delirium: A Systematic Review. J Intensive Care Med. 2022;37(3):408-22. DOI: https://doi.org/10.1177/0885066621997090

ASo A. ASA physical status classification system. ASA House of Delegates. 2014. Available at: https://napanc.ca/assets/Forms/APPENDICES%202018.pdf. Accessed on 10 November 2025.

Chinnarasan VC, Bidkar PU, Swaminathan S, Mani M, Vairappan B, Chatterjee P, et al. Comparison of dexmedetomidine versus fentanyl-based total intravenous anesthesia technique on the requirement of propofol, brain relaxation, intracranial pressure, neuronal injury, and hemodynamic parameters in patients with acute traumatic subdural hematoma undergoing emergency craniotomy: A randomized controlled trial. Surg Neurol Int. 2024;15:462. DOI: https://doi.org/10.25259/SNI_892_2024

Metry AA, Hussain NS, Nakhla GM, Ragaei MZ, Wahba RM. The effect of continuous propofol versus dexmedetomidine infusion on regional cerebral tissue oxygen saturation during cardiopulmonary bypass. Rom J Anaesth Intensive Care. 2019;26(1):17-23.

Denchev K, Gomez J, Chen P, Rosenblatt K. Traumatic Brain Injury: Intraoperative Management and Intensive Care Unit Multimodality Monitoring. Anesthesiol Clin. 2023;41(1):39-78. DOI: https://doi.org/10.1016/j.anclin.2022.11.003

Vu EL, Brown CH, Brady KM, Hogue CW. Monitoring of cerebral blood flow autoregulation: physiologic basis, measurement, and clinical implications. Br J Anaes. 2024;132(6):1260-73. DOI: https://doi.org/10.1016/j.bja.2024.01.043

Jiang Z, Wu Y, Liang F, Jian M, Liu H, Mei H, et al. Brain relaxation using desflurane anesthesia and total intravenous anesthesia in patients undergoing craniotomy for supratentorial tumors: a randomized controlled study. BMC Anesthesiol. 2023;23(1):15. DOI: https://doi.org/10.1186/s12871-023-01970-z

Erdman MJ, Doepker BA, Gerlach AT, Phillips GS, Elijovich L, Jones GM. A comparison of severe hemodynamic disturbances between dexmedetomidine and propofol for sedation in neurocritical care patients. Crit Care Med. 2014;42(7):1696-702. DOI: https://doi.org/10.1097/CCM.0000000000000328

Ren C, Xu H, Xu G, Liu L, Liu G, Zhang Z, et al. Effect of intraoperative infusion of dexmedetomidine on postoperative recovery in patients undergoing endovascular interventional therapies: A prospective, randomized, controlled trial. Brain Behav. 2019;9(7):e01317. DOI: https://doi.org/10.1002/brb3.1317

Thakkar K, Mariappan R, Prabhu K, Yadav B, Singh G. Comparison of Monitored Anesthesia Care with Propofol Versus Dexmedetomidine for Awake Craniotomy: A Retrospective study. J Neuroanaesthesiol Crit Care. 2022;10:87-93. DOI: https://doi.org/10.1055/s-0042-1748195