The safety and efficacy of dexmedetomidine versus propofol for patients undergoing endovascular therapy for acute stroke: A prospective randomized control trial

Abstract

Background: It is uncertain if dexmedetomidine has more favorable pharmacokinetic profile than the traditional sedative drug propofol in patients who undergo endovascular therapy for acute stroke. We conducted a prospective randomized control trial to compare the safety and efficacy of dexmedetomidine with propofol for patients undergoing endovascular therapy for acute stroke.

Methods: A total of 80 patients who met study inclusion criteria were received either propofol (n = 45) or dexmedetomidine (n = 35) between January 2016 and August 2018. We recorded the favorable neurologic outcome (modified Rankin score <3) both at discharge and 3 months after stroke, National Institute of Health Stroke scale (NIHSS) at 48 hours post intervention, modified thrombolysis in myocardial infarction score on digital subtraction angiography, intraprocedural hemodynamics, recovery time, relevant time intervals, satisfaction score of the surgeon, mortality, and complications.

Results: There were no significant differences between the 2 groups (P > .05) with respect to heart rate, respiratory rate, and SPO2 during the procedure. The mean arterial pressure (MAP) was significantly low in the propofol group until 15 minutes after anesthesia was induced. No difference was recorded between the groups at the incidence of fall in MAP >20%, MAP >40% and time spent with MAP fall >20% from baseline MAP. In the propofol group, the time spent with MAP fall >40% from baseline MAP was significantly long (P < .05). Midazolam and fentanyl were similar between the 2 groups (P > .05) that used vasoactive drugs. The time interval from stroke onset to CT room, from stroke onset to groin puncture, and from stroke onset to recanalization/end of the procedure, was not significantly different between the 2 groups (P > .05). The recovery time was longer in the dexmedetomidine group (P < .05). There was no difference between the groups with respect to complications, favorable neurological outcome, and mortality both at hospital discharge and 3 months later, successful recanalization and NIHSS score after 48 hours (P > .05). However, the satisfaction score of the surgeon was higher in the dexmedetomidine group (P < .05).

Conclusions: Dexmedetomidine was undesirable than propofol as a sedative agent during endovascular therapy in patients with acute stroke for a long-term functional outcome, though the satisfaction score of the surgeon was higher in the dexmedetomidine group.

Figure 1

Patient enrollment diagram. This illustrates the flow of all patients screened and excluded.

Figure 2

Intraoperative hemodynamic data monitored between the 2 groups at the following time points: arrival at the operating room (T1), 5 min (T2), 10 min (T3), 15 min (T4), 20 min (T5), 25 min (T6), 30 min (T7), 35 min (T8), 40 min (T9) during the procedure. ^∗P < .05 versus Group P.

Figure 3

Neurological outcome expressed as mRS score both at hospital discharge (A) and 3 months later (B). mRS range, 0 to 6 (0, no symptoms; 1, no clinically relevant disability; 2, slight disability [able to look after own affairs without assistance but not to the full extent]; 3, moderate disability [requires some help but able to walk unassisted]; 4, moderately severe disability [requires assistance and unable to walk unassisted]; 5, severe disability [requires constant nursing care]; 6, dead). mRS = modified Rankin scale.