EMERGING ROLE OF DEXMEDETOMIDINE IN NEUROANESTHESIA: BEYOND SEDATION TO NEUROPROTECTION

Amith M. N.*, Viola Vinita Dsa

ABSTRACT

Background : Dexmedetomidine, a highly selective α2 adrenergic agonist, has gained prominence in neuroanesthesia due to its distinctive sedative, analgesic, and sympatholytic effe cts, accompanied by minimal respiratory depression. Originally employed primarily for sedation in intensive care units, its application has extended into neurosurgical practice, where the maintenance of cerebral blood flow, regulation of intracranial press ure, and facilitation of rapid postoperative recovery are critical. Emerging evidence indicates that dexmedetomidine may provide notable neuroprotective benefits beyond its conventional sedative role. Objectives : This review aims to evaluate the expanding utilization of dexmedetomidine in neuroanesthesia, emphasizing its pharmacological mechanisms, intraoperative applications, and putative neuroprotective effects. Additionally, it synthesizes current clinical evidence, compares dexmedetomidine with traditio nal anesthetic agents, and identifies directions for future research. Methods : A comprehensive review of relevant literature from multiple scientific journals was conducted to collate data on dexmedetomidine’s role in neuroanesthesia. Results : Analysis of both preclinical and clinical studies demonstrates that dexmedetomidine contributes to stable hemodynamic profiles, reduction in cerebral metabolic rate, and preservation of adequate cerebral blood flow. Its anti inflammatory, anti apoptotic, and antioxidant properties confer protectio n against ischemic and inflammatory neural injury. Clinical applications include its use in awake craniotomy, management of traumatic brain injury, and pediatric neuroanesthesia. Nonetheless, dose dependent bradycardia and hypotension remain potential adve rse effects, necessitating careful dose titration. Conclusion : Dexmedetomidine is emerging as a valuable agent in neuroanesthesia with promising neuroprotective attributes. Although current evidence is encouraging, further large scale clinical trials are r equired to optimize dosing regimens and validate long term neurological outcomes. Its evolving role underscores dexmedetomidine’s potential as an integral component of contemporary neuroprotective anesthetic protocols.

Keywords: Dexmedetomidine, Neuroanes thesia, Neuroprotection, Cerebral hemodynamics, Postoperative cognition, ?2 adrenergic agonist.