• G Chaitanya, A Arivazhagan, S Sinha, K R Madhusudan Reddy, K Thennarasu, R D Bharath, M Bhaskara Rao, B A Chandramouli, and P Satishchandra.
• Department of Clinical Neuroscience, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India; Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
• Epilepsy Res. 2015 Jan 1;109:65-71.

BackgroundAnesthetic-induced suppression of cortical electrical activity is a major concern during epilepsy surgery. Dexmedetomidine (Dex) has been recently evaluated in a few small series for its effect on the electrocorticographic spikes intra-operatively.MethodsIn this prospective study, electrocorticogram (ECoG) was monitored during dexmedetomidine infusion in 34 patients (M:F=23:11, age=29.2 ± 10.9 years; duration of epilepsy=15.3 ± 8.9 years) undergoing anterior temporal lobe resection with amygdalo-hippocampectomy for drug-resistant mesial temporal lobe epilepsy (Right: 18, Left: 16). Anesthesia was induced with thiopental/propofol and maintained with oxygen-N2O-isoflurane. ECoG was recorded for 5 min after the end tidal MAC of N2O and isoflurane were decreased to zero; anesthesia was maintained with O2:Air=50:50, vecuronium and fentanyl. ECoG was recorded using a 4-contact strip electrode for: (a) 5 min prior to dexmedetomidine (PreDEX), (b) 5 min during dexmedetomidine infusion (DEX; 1 μg/kg) and (c) 5 min after stopping dexmedetomidine (PostDEX).ResultsThe ECoG spikes were manually counted in all the channels. The mean spike rate in the 2 channels with maximum spikes (MAX CH A and MAX CH B) was normalized to a 3-min duration. RM-ANOVA and post hoc comparison of three phases were used to compare the spike rates. The mean spike rate during Dex phase was higher compared to preDEX (MAX CH B: p=0.007 and MAX CH A: p=0.079) and PostDEX (MAX CH B: p=0.17, MAX CH A: p=0.79) phases. The spike rate increased in 67.6% patients, while 11.8% patients showed ≤ 25% reduction and 20.6% patients showed >25% reduction in spike frequency.ConclusionDexmedetomidine is useful during intra-operative ECoG recording in epilepsy surgery as it enhances or does not alter spike rate in most of the cases, without any major adverse effects.Copyright © 2014 Elsevier B.V. All rights reserved.

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