Dexmedetomidine-ketamine-midazolam combination for sedation in endovascular treatment of cerebral arterio-venous malformations and carotid artery stenosis
Abstract
Background: Immobility, analgesia, anxiolysis, amnesia, preserved patient cooperation and hemodynamic stability without respiratory depression are the requirements for sedation in endovascular treatment of cerebral arteriovenous malformations and carotid artery stenting. The goal of our study was to assess dexmedetomidine-ketamine-midazolam sedation for this use and compare it with routine sufentanil-midazolam sedation.
Methods: 62 patients undergoing elective endovascular neuro-interventions were randomly divided into two groups for sedation. Group A: intravenous bolus application of dexmedetomidine 0.5 mu g/kg, ketamine 0,25 mg/kg and midazolam 0.02 mg/kg during five minutes followed by infusion of dexmedetomidine 0.25 mu g/kg/h and ketamine 0.25 mg/kg/h.
Group B: bolus application of sufentanil 10 mu g and midazolam 0.02 mg/kg. Sedation was then titrated to keep the patient sedated, but responsive to vocal commands.
Parameters which were monitored: blood pressure, ECG, haemoglobin saturation, respiratory rate, arterial carbon dioxide tension, depth of sedation, side effects, complications and recovery. Patient cooperation (excellent-sufficient-poor) was assessed by the radiologist, who was blind to the method used.
Statistical analysis: t-test, chi(2) test, ANOVA. Results: Decreases of blood pressure and heart rate were significantly more marked in group A (p < 0.001), though the number of episodes of hypotension or bradycardia did not differ significantly.
Variability of blood pressure within individual patients was lower in group A (p < 0.05). Cooperation was better in group A (p < 0.001).
No other statistically significant differences were found. No clinically significant complications were recorded.
Conclusion. Sedation by dexmedetomidine-ketamin-midazolam combination seems to be a safe and suitable method for endovascular neuro-interventions.
It secures very good cooperation with the patient and hemodynamic stability without respiratory depression.