Monitored Anesthesia Care: Dexmedetomidine-Ketamine Versus Dexmedetomidine- Propofol For Chronic Subdural Hematoma

Zagazig University56 enrolled

Overview

Inadequate sedation and analgesia indicated by intraoperative movements are markers of inadequate MAC during burr-hole surgery for chronic subdural hematoma evacuation especially when general anesthesia poses high risk for the patients. Dexmedetomidine, ketamine, propofol intravenous infusion and other agents was used to provide monitored anesthesia care with variable success if used as solitary agents as each drug has its limited use.

* Null hypothesis (H0): There are no differences between the effects of dexmedetomidine- ketamine and dexmedetomidine- propofol combination for monitored anesthesia care during burr-hole surgery for chronic subdural hematoma evacuation. * Alternative hypothesis (H1): There are differences between the effects of dexmedetomidine- ketamine and dexmedetomidine- propofol combination for monitored anesthesia care during burr-hole surgery for chronic subdural hematoma evacuation.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

Conscious Sedation

Interventions

dexmedetomidine- ketamineDRUG

patients will receive combination of ketamine 1mg/kg and dexmedetomidine 1ug/kg diluted in 10 ml 0.9% saline infused over 10 min together as an intravenous bolus dose then a maintenance of 0.5ug/kg/h dexmedetomidine and ketamine 0.5 mg/kg/h continuous infusion in two separate syringes pump to achieve modified Observer's Assessment of Alertness and sedation score (OAA/S) 3 and the infusion will stopped by finishing the skin suture.

dexmedetomidine- propofolDRUG

patients will receive combination from 0.5 mg/kg propofol and dexmedetomidine 1ug/kg diluted in 10 ml 0.9% saline infused over 10 min together as an intravenous bolus dose then a maintenance of 0.5ug/kg/h dexmedetomidine and propofol 0.5 mg/kg/h continuous infusion in two separate syringes pump to achieve modified Observer's Assessment of Alertness and sedation score (OAA/S) 3 and the infusion will stopped by finishing the skin suture.

Eligibility

Sex: ALLMin age: 50 YearsMax age: 80 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Patient acceptance. * Both sex. * Age (50-80) years old. * Patient with Body Mass Index (BMI) (25-30kg/m²). * American Society of Anesthesiologist (ASA) II / III * patient scheduled to burr-hole surgery for chronic subdural hematoma evacuation under MAC. Exclusion Criteria: * Patient with difficult airway (mallapati III,IV). * Altered mental status (psychiatric and anexity disorder). * Post-traumatic stress disorders. * History of allergy to study drugs. * Patient on sedative or hypnotic medication. * Patients with on painkiller. * Patients with any degree of heart block. * Sever liver, respiratory or renal impairment.

Locations (1)

Zagazig University Hospitsals

Zagazig, Egypt

Outcomes

Primary Outcomes

The onset time of sedation

The onset of sedation will be recorded. It is defined as the time from injection of sedative medications till reaching a target sedation level score 3 by modified Observer's Assessment of Alertness and sedation score (OAA/S).

Time frame: with in 30 minutes before start of surgery

Secondary Outcomes

The extent of airway obstruction

The extent of airway obstruction by (1= patent airway, 2= airway obstruction alleviated by jaw thrust, 3= airway obstruction alleviated by positive mask ventilation)

Time frame: intraopertive

rescue analgesic (fentanyl)

Total number of calling intraoperative rescue analgesic (fentanyl) in both groups will be recorded.

Time frame: intraoperative

number of participant with complications

Intraoperative complications such as hypotension (mean arterial blood pressure decreases by \> 20% of basal reading), bradycardia (HR decreases by \> 20% of basal reading) and bradypnea (RR less than 10 b/m) or hypoxemia (SpO2 less than 95%

Time frame: intraoperative

Recovery time

Recovery time: time from discontinuation of infusion drugs till spontaneous eye opening.

Time frame: with in one hour postoperative

The Neurological status of participants

The Neurological status of participants will be assessed before discharge in the PACU using Markwalder's Neurological Grading scale (MNGs) and recorded: Grade 0: no neurologic deficit Grade I: mild symptoms such as headache; absent or mild neurologic deficits such as reflex asymmetry Grade II: drowsiness or disorientation with variable neurologic deficits such as hemiparesis Grade III: stupor, but appropriate responses to noxious stimuli; severe focal signs such as hemiplegia Grade IV: coma with absence of motor response to painful stimuli; decerebrate or decorticate posturing.

Data from ClinicalTrials.gov

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