Effect of Dexmedetomidine versus Propofol on Intraoperative Seizure Onset During Awake Craniotomy: A Retrospective Study

Introduction: The effect of dexmedetomidine (DEX) compared with propofol on intraoperative seizures (IOS) detected using electrocorticography (ECoG) during awake craniotomy for resection of brain tumors is unknown. This investigation aimed at comparing the IOS rate between patients receiving dexmedetomidine or propofol as sedative agent. Material and methods: In this retrospective single-center study, awake craniotomies performed from January 2014 to December 2019 were analyzed. All intraoperative seizures detected by ECoG as well as vital parameters were recorded. Results: One hundred sixty-eight adults were enrolled into the study, 58 managed with DEX and 110 with propofol. IOS occurred more frequently in the DEX group (22%) compared with propofol group (11%) (p=0.046). A higher incidence of bradycardia was also observed in the DEX group (p<0.001). Higher incidence of hypertension and a higher mean heart rate were recorded in the propofol group (p=0.006 and p<0.001, respectively). No serious adverse events requiring active drug administration were noted in both groups. At univariate regression analysis, DEX demonstrated a tendency to favor IOS onset but without statistically significance (OR=2.36, p=0.051). Patients in the DEX and propofol groups had a similar epileptological outcome at the one-year postoperative follow-up. Conclusions: IOS detected with ECoG during awake craniotomy occurred more frequently in DEX than propofol group. However, the former did not demonstrate to be a statistically significant risk factor for IOS onset, resulting to be a valid alternative to propofol during awake craniotomy, in patients affected by tumor-related epilepsy.