Effectiveness of Dexmedetomidine Versus Sufentanil on Cerebral Oxygen Saturation in Patients With Traumatic Brain Injury

Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide, often leading to secondary brain injury caused by hypoxia, ischemia, and impaired cerebral autoregulation. During anesthesia and surgery, maintaining adequate cerebral oxygenation is critical to prevent secondary neuronal damage. Cerebral oxygen saturation, measured by Near-Infrared Spectroscopy (NIRS), provides a continuous and noninvasive assessment of regional cerebral oxygenation (rSO₂), reflecting the balance between oxygen delivery and consumption in brain tissue.

Opioids such as sufentanil have traditionally been used to provide analgesia and hemodynamic stability during anesthesia in neurosurgical patients. However, opioid-related adverse effects, including respiratory depression, hypercapnia, and potential increases in intracranial pressure, raise concerns in patients with brain injury. Dexmedetomidine, a selective α₂-adrenergic receptor agonist, has sedative, analgesic, and sympatholytic properties without significant respiratory depression. It is known to reduce cerebral metabolic rate and intracranial pressure while maintaining cerebral perfusion, making it a potentially advantageous agent in neuroanesthesia.

This randomized controlled clinical trial aims to compare the effectiveness of dexmedetomidine versus sufentanil on cerebral oxygen saturation in patients with traumatic brain injury undergoing surgery. The hypothesis is that dexmedetomidine provides better maintenance of cerebral oxygenation, as measured by NIRS, compared to sufentanil under equivalent anesthetic conditions.

Eligible participants will be randomly allocated into two groups (1:1 ratio). The dexmedetomidine group will receive an induction dose of dexmedetomidine 1 µg/kg, thiopental 5 mg/kg, and rocuronium 0.6 mg/kg, followed by maintenance with dexmedetomidine 0.3 µg/kg/hour and sevoflurane 1-1.5 vol%. The sufentanil group will receive sufentanil 0.2 µg/kg, thiopental 5 mg/kg, and rocuronium 0.6 mg/kg, followed by sufentanil 0.2 µg/kg/hour and sevoflurane 1-1.5 vol%. All patients will receive intravenous paracetamol 1 g at the end of surgery for postoperative analgesia.

Postoperatively, patients will remain intubated and monitored in the Intensive Care Unit (ICU). Cerebral oxygen saturation (rSO₂) will be recorded using NIRS probes placed bilaterally on the frontal region before induction, during surgery, and at 60 and 120 minutes post-intervention in the ICU. Additional hemodynamic parameters including heart rate, mean arterial pressure, and oxygen saturation will also be recorded.

The primary outcome of this study is the change in cerebral oxygen saturation (rSO₂) between the two groups. Data obtained will be analyzed statistically to determine the comparative effectiveness of dexmedetomidine and sufentanil in maintaining optimal cerebral oxygenation during neurosurgical anesthesia in patients with traumatic brain injury. Findings from this study are expected to provide evidence-based recommendations for optimizing anesthetic management in neurotrauma cases, minimizing secondary brain injury, and improving patient outcomes.

Inclusion criteria

• Patients aged 18-65 years diagnosed with traumatic brain injury (TBI) requiring surgical intervention under general anesthesia.
• Classified as ASA Physical Status I-III.
• Undergoing elective or emergency craniotomy at RSUD Prof. Dr. Margono Soekarjo Purwokerto.
• Provide informed consent (patient or legal representative).

Exclusion criteria

• Patients with severe cardiovascular instability (e.g., shock, uncontrolled arrhythmia).
• History of allergy or hypersensitivity to dexmedetomidine or sufentanil.
• Severe hepatic or renal impairment.
• Pregnant or lactating women.
• Glasgow Coma Scale ≤ 8 before induction.
• Refusal of participation or incomplete consent.