Comparison of dexmedetomidine and droperidol-fentanyl for asleep-awake-asleep techniques in awake craniotomy anesthesia: a randomized controlled study

Abstract Background In this study, we aimed to compare dexmedetomidine with droperidol-fentanyl during the intraoperative awakening phase of awake craniotomy (AC), focusing on wake-up time. Methods We conducted a single-center randomized controlled trial in China from January 2018 to December 2018. Patients aged 36–60 years, with American Society of Anesthesiologists physical status I–II, scheduled for brain glioma resection, were screened for eligibility; 61 were randomized, and 60 were included in the final analysis. The patients were randomized to either the dexmedetomidine group (intravenous loading dose of dexmedetomidine 0.5 µg·kg − 1 after discontinuation of propofol and remifentanil, followed by a maintenance infusion of dexmedetomidine 0.3–0.5 µg·kg − 1 ·h − 1 ) or the droperidol-fentanyl group (intravenous loading doses of fentanyl 2 µg·kg − 1 and droperidol 5 mg after discontinuation of propofol and remifentanil, followed by continuous maintenance infusions of fentanyl 2 µg·kg − 1 ·h − 1 and droperidol 0.1 mg·kg − 1 ·h − 1 ). A wake-up assessment was performed during maintenance of the assigned study regimen. The primary outcome measure was wake-up time. Secondary outcomes included the Observer’s Assessment of Alertness/Sedation (OAA/S) scale, Numerical Rating Scale (NRS), eloquent brain area mapping status, vital signs, and adverse events. Results Baseline characteristics were comparable between the groups. Compared with the droperidol-fentanyl group, the dexmedetomidine group had lower mean arterial pressure at T4-T7, lower heart rate at T1-T4 and T7, and a shorter wake-up time, with a between-group difference of 3.5 min (95% CI, 1.95 to 5.05; P < 0.001). No statistically significant differences were detected in OAA/S scores at wake-up (T2), NRS scores, eloquent area mapping status, or adverse events between the groups. Conclusion No statistically significant differences were detected in OAA/S scores at wake-up or intraoperative brain mapping performance between the two groups. The dexmedetomidine regimen was associated with a shorter measured wake-up time. Trial registration The Chinese Clinical Trial Registry (ChiCTR1800014329) was retrospectively registered on 6 January 2018.