Is dexmedetomidine a favorable agent for cerebral hemodynamics?

Hemodynamic stability, with special attention to arterial pressure in order to warrant an adequate cerebral perfusion, is a cornerstone of neuroanesthesia (NA) and neurocritical care (NCC) management. An abrupt elevation of arterial blood pressure can aggravate cerebral edema or induce cerebral hematoma, resulting in a prolonged NCC unit stay. On the other hand, hypotension is associated with an increased risk for cerebral ischemia that is more pronounced when autoregulation of cerebral blood flow (CBF) is impaired, and there is a compromised cerebral compliance. [1,2] However, NCC encompasses subgroups of patients such as traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), and intracerebral hemorrhage ones in whom there is the unique need to maintain supranormal blood pressure values with a view to ensure adequate cerebral perfusion and to optimize outcome.[1-3] Moreover, any derangement of cerebrovascular hemodynamics may contribute to intracranial pressure (ICP) elevation with concomitant cerebral perfusion pressure (CPP) deterioration, which can further exacerbate ischemic damage.[3]