Mild Sedation Exacerbates or Unmasks Focal Neurologic Dysfunction in Neurosurgical Patients with Supratentorial Brain Mass Lesions in a Drug-specific Manner
| Autor: | Jianxin Zhou, Adrian W. Gelb, Ruquan Han, Nan Lin |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.drug_class Midazolam Sedation Supratentorial region Neurosurgical Procedures Fentanyl Young Adult 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology medicine Humans Hypnotics and Sedatives Single-Blind Method Prospective Studies Dexmedetomidine business.industry Supratentorial Neoplasm Supratentorial Neoplasms Middle Aged Anesthesiology and Pain Medicine medicine.anatomical_structure Sedative Anesthesia Female Nervous System Diseases medicine.symptom business Propofol 030217 neurology & neurosurgery Follow-Up Studies medicine.drug |
| Zdroj: | Anesthesiology. 124:598-607 |
| ISSN: | 0003-3022 |
| Popis: | BackgroundSedation is commonly used in neurosurgical patients but has been reported to produce transient focal neurologic dysfunction. The authors hypothesized that in patients with frontal–parietal–temporal brain tumors, focal neurologic deficits are unmasked or exacerbated by nonspecific sedation independent of the drug used.MethodsThis was a prospective, randomized, single-blind, self-controlled design with parallel arms. With institutional approval, patients were randomly assigned to one of the four groups: “propofol,” “midazolam,” “fentanyl,” and “dexmedetomidine.” The sedatives were titrated by ladder administration to mild sedation but fully cooperative, equivalent to Observer’s Assessment of Alertness and Sedation score = 4. National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the neurologic function before and after sedation. The study’s primary outcome was the proportion of NIHSS-positive change in patients after sedation to Observer’s Assessment of Alertness and Sedation = 4.ResultsOne hundred twenty-four patients were included. Ninety had no neurologic deficits at baseline. The proportion of NIHSS-positive change was midazolam 72%, propofol 52%, fentanyl 27%, and dexmedetomidine 23% (P less than 0.001 among groups). No statistical difference existed between propofol and midazolam groups (P = 0.108) or between fentanyl and dexmedetomidine groups (P = 0.542). Midazolam and propofol produced more sedative-induced focal neurologic deficits compared with fentanyl and dexmedetomidine. The neurologic function deficits were mainly limb motor weakness and ataxia. Patients with high-grade gliomas were more susceptible to the induced neurologic dysfunction regardless of the sedative.ConclusionsMidazolam and propofol augmented or revealed neurologic dysfunction more frequently than fentanyl and dexmedetomidine at equivalent sedation levels. Patients with high-grade gliomas were more susceptible than those with low-grade gliomas. |
| Databáze: | OpenAIRE |
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