Effect of Dexmedetomidine Versus Propofol Sedation on The Cerebral Blood Flow Velocity and Cerebral Metabolic Rate of Oxygen in Patients With Traumatic Brain Injuries

Background: Every year, Traumatic brain injury (TBI) affects people all over the world in a significant way. In the treatment of TBI, sedatives are employed as neuroprotectors to lower intracranial pressure (ICP) and the cerebral metabolic rate of oxygen (CMRO2). The aim of the work was to compare the efficacy of dexmedetomidine versus propofol in TBI patients regarding the cerebral blood flow velocity (CBFV), CMRO2 and 28-day mortality. Methods: This prospective clinical double-blinded randomized study was conducted on 72 patients with TBI. The patients were allocated equally into group D (dexmedetomidine), group P (propofol) and given sedation for 48hrs. Richmond Agitation-Sedation Scale was used for assessment Of sedation level. Jugular venous bulb oxygen saturation (SjVO2) and transcranial Doppler measurements of middle cerebral artery (MCA) flow velocity and diameter(d) were recorded at admission, 6 hr, 12hr, 24hr and 48hr. Results: Both dexmedetomidine and propofol are comparable for managing TBI. There was a significant reduction in cerebral perfusion pressure (CPP) and CMRO2 in each group, but CBF showed an increase with both sedatives. Propofol exhibited a more increase in CBFV. However, neither sedative significantly affected ICP nor 28-mortality rate. Conclusion: In patients with TBI, dexmedetomidine and propofol sedative agents showed comparable effect on mean arterial pressure (MAP), ICP, CPP, CBF, CMRO2 and mortality rate but HR and mean flow velocity (MFV) were significantly less with dexmedetomidine than propofol. While both sedatives decrease MAP, HR, CPP, CMRO2 and MCA diameter and increase MFV, CBF and SjVO2 when compared to admission values.