New Insights into the Pharmacology of Dexmedetomidine and Open Issues for Neurosurgical Procedures

Patients undergoing neurosurgical procedures or requiring mechanical ventilation at the end of the neurosurgical procedure need analgosedation to reduce the anxiety and discomfort related to the intervention, as well as to minimize ventilator intolerance and desynchronizations. Dexmedetomidine is an alpha2-adrenergic agonist (C13H16HCl), as clonidine but more selective for alpha2-receptor. Dexmedetomidine has become increasingly popular for use in neurosurgical procedures and intensive care units (ICU) due to its proposed peculiarities for the management of systemic and cerebral hemodynamics, and the need for intraoperative cortical mapping. Nowadays the approved therapeutic indication of the European Medical Agency for dexmedetomidine is the sedation of adult ICU patients, whereas the recommended use of the Food and Drug Administration, besides the sedation of adult ICU patients, is the sedation of non-ICU patients prior or during surgical and interventional procedures. However, in many studies, dexmedetomidine is used off-label. This chapter would be a quick overview of the dexmedetomidine use in neurosurgical procedures, providing new insights into its pharmacology.