Published: 2017-01-16

A comparative study between dexmedetomidine and propofol for maintaining depth of anesthesia in elective craniotomy: a prospective randomized double blind study

Amrita Roy, Suman Sarkar, Anirban Chatterjee, Anusua Banerjee


Background: The objective of present study was to assess the efficacy of dexmedetomidine over propofol in maintaining depth of anesthesia in patients undergoing elective craniotomy.

Methods: Ninety patients of American Society of Anaesthesiologists (ASA) physical status 1 or 2, of either sex, with Glasgow Coma Score (GCS) 14 or 15, scheduled for elective craniotomy, were allocated in two groups, Group D and Group P. Each group consisted of 45 patients. Anesthesia was induced with propofol and maintained with nitrous oxide in oxygen, atracurium and intermittent fentanyl. Patients in Group D received continuous infusion of dexmedetomidine 0.4 µg/kg/hour which was started after induction and stopped after closure of dura in and patients in Group P received continuous infusion of propofol 100 µg/kg/min in same manner. Heart Rate (HR), mean arterial pressure (MAP), and bispectral index (BIS) were recorded and compared at specific time points which are known to have hemodynamic alterations throughout the intraoperative period.

Results: Dexmedetomidine was comparable and even better (after intubation p 0.02, head pin fixation p 0.00, opening of dura p <0.00) than propofol in maintaining depth of anesthesia. It also attenuated HR and MAP at intubation, head pin fixation, skin incision, making of burr hole, opening of dura and at extubation (p 0.00). But Ramsay sedation score of patients after extubation in both groups did not differ significantly (p 0.36). No patient had recall.

Conclusions: Dexmedetomidine is comparable with propofol in maintaining depth of anesthesia during elective craniotomy. It can be used as a sole anesthetic agent during craniotomy.



BIS, Dexmedetomidine, Craniotomy, Intraoperative awareness, Depth of anesthesia, Recall

Full Text:



Sandin RH, Enlund G, Samuelsson P, Lennmarken C. Awareness during anaesthesia: a prospective case study. Lancet. 2000;355:707-11.

Akavipat P, Sookplung P, Muansaiyart P. The Thai anesthesia incident monitoring study (Thai AIMS): an analysis of 21 awareness events. J Med Assoc Thai. 2009;92:335-41.

Akavipat P. Bispectral index. Thai J Anesth. 2001;26:261-7.

Jagia M, Prabhakar H, Dass HH. Comparative evaluation of spectral entropy and bispectral index during propofol/thiopentone anaesthesia in patients with supratentorial tumours - a preliminary study. Indian J Anaesth. 2008;52(2):175-8.

Gunes Y, Gunduz M, Ozcengiz D, Ozbek H, Isik G. Dexmedetomidine-remifentanil or propofol-remifentanil anesthesia in patients undergoing intracranial surgery. Neurosurg Q. 2005;15:122-6.

Tanskanen P, Kytta J, Randell T, Aantaa R. Dexmedetomidine as an anaesthetic adjuvant in patients undergoing intracranial tumor surgery: a double-blind, randomized and placebo-controlled study. Br J Anaesth. 2006;97:658-65.

Huupponen E, Maksimow A, Lapinlampi P, Sarkela M, Saastamoinen A, Snapir A, et al. Electroencephalogram spindle activity during dexmedetomidine sedation and physiological sleep. Acta Anaesthesiol Scand. 2008;52:289-94.

Scheinin B, Lindgren L, Randell T, Scheinin H, Scheinin M. Dexmedetomidine attenuates sympathoadrenal response to tracheal intubation and reduces the need for thiopentone and peroperative fentanyl. Br J Anaesth. 1992;68:126-31.

Domino KB, Posner KL, Caplan RA, Cheney FW. Awareness during anesthesia - a closed claim analysis. Anesthesiology. 1999;90:1053-61.

Sandlin D. A closer look at bispectral index monitoring. J Perianesth Nurs. 2001;16:420-2.

Ishizawa Y. Mechanisms of anesthetic actions and the brain. J Anesth. 2007;21:187-99.

Ropcke H, Konen- Bergman M, Cuhls M, Bouillon T, Hoeft A. Propofol and remifentanil pharmacodynamic interaction during orthopaedic surgical procedures as measured by effects on bispectral index. J Clin Anesthesiol. 2001;13:198-207.

Rosow C, Manberg PJ. Bispectral index monitoring. Anesthesiol Clin North Am. 2001;19:947-66.

Roy A, Sarkar S, Santra S, Banerjee A, Ganguly S. Role of dexmedetomidine on hemodynamics and anesthetic requirement during elective intracranial tumor surgery - a prospective randomized double blind placebo controlled study. J Clin Sci Med Res. 2015;3(8):7236-47.

Jakob SM, Ruokonen E, Grounds RM, Sarapohja T, Garrat C, Pocock SJ, et al. Dexmedetomidine vs. midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized control trials. JAMA. 2012;307:1151-60.

Kasuya Y, Govinda R, Rauch S, Mascha EJ, Sessler DI, Turan A. The correlation between bispectral index and observational sedation scale in volunteers sedated with dexmedetomidine and propofol. Anaesth Analg. 2009;109:1811-5.

Chattopadhyay U, Mallik S, Ghosh S, Bhattacharya S, Bisai S, Biswas H. Comparison between propofol and dexmedetomidine on depth of anesthesia: a prospective randomized trial. J Anaesthesiol Clin Pharmacol. 2014;30:550-4.

Myles PS, Leslie K, McNeil J, Forbes A, Chan MTV. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Lancet. 2004;363:1757-63.