Is Dexmedetomidine More Effective Than Remifentanil for Neurologic Outcomes in Patients Undergoing CEA Surgery Using Regional Anesthesia?

Carotid endarterectomy (CEA) surgery is performed using regional anesthesia and intravenous/sedative drugs, such as dexmedetomidine and remifentanil. It is unclear which drug provides the least amount of hemodynamic variability, sedation, and respiratory depression so cognitive function can be continuously monitored intraoperatively. A search of the literature was conducted to identify the evidence of the effects of dexmedetomidine and remifentanil in patients undergoing awake CEA surgery with regional anesthesia. A literature search was conducted using Google Scholar, Cumulative Index to Nursing and Allied Health Literature, PubMed, MEDLINE, and the Cochrane Systematic Review databases. Four randomized control studies and a retrospective study were critically appraised to evaluate the evidence on the effectiveness of dexmedetomidine compared with remifentanil during CEA surgery, using regional anesthesia and dexmedetomidine or remifentanil from 2004 to 2009. These studies found that dexmedetomidine provides adequate sedation with less respiratory depression than remifentanil when used in adjunct with regional anesthesia, allowing the provider to monitor hemodynamic stability and neurologic status continuously during the intraoperative period. Dexmedetomidine was evaluated as the primary agent of choice for sedation when performing an awake CEA with regional anesthesia.