Dexmedetomidine for Conscious Sedation and Controlled Hypotension in Head and Neck Surgery: A Single-Centre Experience

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Abstract
Background and Objectives: Elderly patients with head and neck tumours frequently present with multiple comorbidities and a potentially difficult airway, making general anaesthesia high-risk. Dexmedetomidine, a selective alpha-2 adrenoceptor agonist, provides conscious sedation without clinically significant respiratory depression, offering a compelling locoregional alternative. This study evaluated the haemodynamic profile, sedation kinetics, and satisfaction outcomes of a standardised dexmedetomidine-based protocol for head and neck surgery under local infiltration anaesthesia. Materials and Methods: A prospective, single-centre observational study was conducted at the University Hospital Centre Zagreb. Twenty-three consecutive adult patients received a continuous dexmedetomidine infusion at 0.5 μg/kg/h, initiated preoperatively in the post-anaesthesia care unit without a loading dose. Haemodynamic parameters, sedation-to-incision interval, cumulative dose, and postoperative patient and surgeon satisfaction (NRS 1–10) were recorded. Spearman rank-order correlation and the Mann–Whitney U test were used for statistical analysis. Results: The primary outcome of haemodynamic stability—defined as the absence of vasoactive or inotropic rescue—was achieved in all 23 patients (100%). The median cumulative dexmedetomidine dose was 52 μg (IQR 44–68 μg). Controlled hypotension was achieved in all patients, with a median nadir systolic blood pressure of 98 mmHg. Supplemental oxygen was required in only 2 of 23 patients (8.7%). Patient and surgeon satisfaction reached a median NRS score of 10 in both groups. The sedation-to-incision interval correlated with total drug dose (ρ = 0.74, p < 0.001), consistent with fixed-rate infusion pharmacokinetics. Hypertensive patients exhibited a greater reduction in systolic blood pressure (median 45 vs. 28 mmHg; p = 0.015). Conclusions: A fixed-rate dexmedetomidine infusion initiated in the post-anaesthesia care unit provides a feasible and potentially effective conscious sedation strategy for head and neck surgery under local infiltration anaesthesia in selected elderly and comorbid patients. In this pilot series, the protocol was associated with haemodynamic stability in all cases, low supplemental oxygen requirements, and high procedural satisfaction among both patients and surgeons. These findings are preliminary and require confirmation in larger, controlled studies.

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