Role of intraoperative dexmedetomidine infusion in endovascular intervention for aneurysmal subarachnoid hemorrhage: a randomized controlled trial

BACKGROUND: Cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH) remains as a major contributor to death. This study evaluated the efficacy of intraoperative dexmedetomidine (DEX) infusion in reducing cerebral vasospasm incidence during endovascular intervention for aneurysmal SAH. METHODS: A randomized, placebo-controlled, triple-blind research involved ninety individuals with unruptured aneurysmal SAH. Endovascular intervention participants were given either DEX at a loading dose of 0.5 μg/kg and a maintenance infusion of 0.2-0.6 μg/kg/h according to hemodynamics (heart rate, mean arterial pressure), or normal saline (0.9%) as a placebo, according to a random assignment. RESULTS: The rate of vasospasm was noticeably lower in the DEX group (13.33% vs. 33.33%, P=0.025) and the relative risk was 0.4 (95% CI 0.17-0.94). The time to first rescue analgesia was also longer in the DEX group (9.84±1.62 vs. 3.4±1.16 hours, P<0.001), and the total amount of morphine consumed in the first two days was noticeably lower in the DEX group (P<0.001). After thirty minutes, hemodynamic parameters were more stable. No significant differences were noted in cerebral infarction rates or adverse events, nor in the Extended Glasgow Outcome Scale (EGOS) at one month. CONCLUSIONS: Intraoperative DEX infusion significantly reduced vasospasm incidence while providing superior pain control and hemodynamic stability, without increasing adverse events. These findings suggest DEX as a promising adjunct for endovascular management of aneurysmal SAH.