Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun 8;12(6):752.
doi: 10.3390/brainsci12060752.

Comparing the Effect of Dexmedetomidine and Midazolam in Patients with Brain Injury

Yanxia Huang  1 , Yunxin Deng  1 , Renjing Zhang  1 , Mei Meng  1 , Dechang Chen  1
Affiliations

Comparing the Effect of Dexmedetomidine and Midazolam in Patients with Brain Injury

Yanxia Huang et al. Brain Sci. .

Abstract

Background: Studies have shown that dexmedetomidine improves neurological function. Whether dexmedetomidine reduces mortality or improves quantitative electroencephalography (qEEG) among patients post-craniotomy remains unclear.

Methods: This single-center randomized study was conducted prospectively from 1 January 2019 to 31 December 2020. Patients who were transferred to the ICU after craniotomy within 24 h were included. The analgesic was titrated to a Critical care Pain Observation Tool (CPOT) score ≤2, and the sedative was titrated to a Richmond Agitation-Sedation Scale (RASS) score ≤-3 for at least 24 h. The qEEG signals were collected by four electrodes (F3, T3, F4, and T4 according to the international 10/20 EEG electrode practice). The primary outcome was 28-day mortality and qEEG results on day 1 and day 3 after sedation.

Results: One hundred and fifty-one patients were enrolled in this study, of whom 77 were in the dexmedetomidine group and 74 in the midazolam group. No significant difference was found between the two groups in mortality at 28 days (14.3% vs. 24.3%; p = 0.117) as well as in the theta/beta ratio (TBR), the delta/alpha ratio (DAR), and the (delta + theta)/(alpha + beta) ratio (DTABR) between the two groups on day 1 or day 3. However, both the TBR and the DTABR were significantly increased in the dexmedetomidine group. The DTABR in the midazolam group was significantly increased. The DAR was significantly increased on the right side in the dexmedetomidine group (20.4 (11.6-43.3) vs. 35.1 (16.7-65.0), p = 0.006) as well as on both sides in the midazolam group (Left: 19.5 (10.1-35.8) vs. 37.3 (19.3-75.7), p = 0.006; Right: 18.9 (10.1-52.3) vs. 39.8 (17.5-99.9), p = 0.002).

Conclusion: Compared with midazolam, dexmedetomidine did not lead to a lower 28-day mortality or better qEEG results in brain injury patients after a craniotomy.

Keywords: dexmedetomidine; midazolam; post-craniotomy; qEEG; sedative.

PubMed Disclaimer

Conflict of interest statement

All authors report no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Electroencephalography electrode setup. Four conventional EEG recording sites were used in accordance with the international 10/20 system.
Figure 2
Figure 2
Flowchart of enrollment in the study. GCS: Glasgow Coma score.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Carney N., Totten A.M., O’Reilly C., Ullman J.S., Hawryluk G.W., Bell M.J., Bratton S.L., Chesnut R., Harris O.A., Kissoon N., et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurger. 2017;80:6–15. doi: 10.1227/NEU.0000000000001432. - DOI - PubMed
    1. Shen H., Ma X., Wu Z., Shao X., Cui J., Zhang B., Abdelrahim M.E., Zhang J. Conscious sedation compared to general anesthesia for intracranial mechanical thrombectomy: A meta-analysis. Brain Behav. 2021;11:e02161. doi: 10.1002/brb3.2161. - DOI - PMC - PubMed
    1. Wu B., Hu H., Cai A., Ren C., Liu S. The safety and efficacy of dexmedetomidine versus propofol for patients undergoing endovascular therapy for acute stroke: A prospective randomized control trial. Medicine. 2019;98:e15709. doi: 10.1097/MD.0000000000015709. - DOI - PMC - PubMed
    1. Roberts I., Sydenham E. Barbiturates for acute traumatic brain injury. Cochrane Database Syst. Rev. 2012;12:CD000033. doi: 10.1002/14651858.CD000033.pub2. - DOI - PMC - PubMed
    1. Roberts D.J., Hall R.I., Kramer A.H., Robertson H.L., Gallagher C.N., Zygun D.A. Sedation for critically ill adults with severe traumatic brain injury: A systematic review of randomized controlled trials. Crit. Care Med. 2011;39:2743–2751. doi: 10.1097/CCM.0b013e318228236f. - DOI - PubMed

LinkOut - more resources