Neurocognition after Electroencephalography Guided Anesthetic Induction with Dexmeditomidine in Neurosurgical Patients: A Case Series

The use of Dexmeditomidine as the primary agent for induction of anesthesia has only been sparingly described due to the concern of quality of anesthetic induction. Although the use of dexmeditomidine has been described for awake craniotomies during the initial phase of sleep-awake-sleep cycle, its use in other forms of neurosurgery has been sparingly described. In this case series we explored the feasibility of combining dexmedetomidine with sevoflurane in an anesthetic induction algorithm. All patients achieved smooth anesthetic induction with introduction of sevoflurane after 8 minutes of dexmeditomidine infusion @ 0.6 mcg/kg/min. The whole induction process was carried out in continuous EEG monitoring using the double banana montage in all patients. Quality of anesthetic induction was evaluated by Viby-Mogensen's criteria and the postoperative cognitive parameters evaluated by Montreal Cognitive Assessment (MoCA) score and Confusion Assessment Method - Short form (CAM-S) score ruled out cognitive decline in this present case series.We conclude that a structured anesthetic induction algorithm incorporating dexmeditomidine with sevoflurane followed by optimal intraoperative hemodynamics and anesthetic maintenance, can enhance patient outcomes and postoperative cognitive function.