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Dexmedetomidine is an alpha-2 agonist commonly used during neurosurgery due to its unique properties as a sedative and anxiolytic with minimal respiratory depression. Neurosurgical patients frequently come to the operating room on anticonvulsant therapy with a history of seizures. The investigators clinical experience suggests that these patients are resistant to the sedative effects of dexmedetomidine. This effect may represent a pharmacokinetic interaction between the anticonvulsant medications and dexmedetomidine or the higher dexmedetomidine dose requirement could result from abnormal pharmacodynamics due to the underlying seizure disorder. The investigators study aims to investigate the pharmacokinetic and pharmacodynamic differences of dexmedetomidine between patients receiving and not receiving enzyme-inducing anticonvulsant therapy and to identify a potential mechanism for these differences.
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Dexmedetomidine | Drug | Dexmedetomidine will be administered to 2 groups: (1) Seizure disordered patients on anticonvulsants and (2) Healthy volunteers (Control group) |
|
| Measure | Description | Time Frame |
|---|---|---|
| Serum level of dexmedetomidine | Serum levels of dexmedetomidine will be taken at specific intervals during and after a step-wise computer controlled infusion of dexmedetomidine. | 0-8 hour period |
| Measure | Description | Time Frame |
|---|---|---|
| Patient State Index (PSI) and Entropy | PSI and/or state entropy will be recorded at specific intervals during and after a step-wise computer controlled infusion of dexmedetomidine. | 0-8h |
| Visual Analog Scale score |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Alana M Flexman, MD | UCSF Department of Anesthesia | Principal Investigator |
| Pekka Talke, MD | UCSF Department of Anesthesia | Principal Investigator |
| Paul Garcia, MD | UCSF Department of Neurology | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of California San Francisco | San Francisco | California | 94122 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 29933272 | Derived | Sleigh JW, Vacas S, Flexman AM, Talke PO. Electroencephalographic Arousal Patterns Under Dexmedetomidine Sedation. Anesth Analg. 2018 Oct;127(4):951-959. doi: 10.1213/ANE.0000000000003590. |
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| ID | Term |
|---|---|
| D004827 | Epilepsy |
| D012640 | Seizures |
| ID | Term |
|---|---|
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D009461 | Neurologic Manifestations |
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| ID | Term |
|---|---|
| D020927 | Dexmedetomidine |
| ID | Term |
|---|---|
| D007093 | Imidazoles |
| D001393 | Azoles |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
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VAS scores will be recorded at specific intervals during and after a step-wise computer controlled infusion of dexmedetomidine.
| 0-8h |
| Ramsay Sedation Score | Ramsay sedation scores will be recorded at specific intervals during and after a step-wise computer controlled infusion of dexmedetomidine. | 0-8h |
| Observer's Assessment of Alertness/Sedation Score (OAA/S) | OAA/S scores will be recorded at specific intervals during and after a step-wise computer controlled infusion of dexmedetomidine. | 0-8h |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |