Changes in cognitive function (mental abilities) after anesthesia and surgery ranges from emergence delirium (ED), postoperative delirium (POD) to long-term postoperative cognitive dysfunction (POCD). Patients undergoing brain surgeries are likely to have a higher incidence of ED/POD/POCD due to pre-existing brain pathologies and also from direct handling of the brain during surgery. Brain surgery may also increase perioperative stress hormones and inflammatory markers which may add to postoperative cognitive changes. Dexmedetomidine is a widely used in the anesthetic practice which provides sedation and analgesia, ameliorates surgical stress, and has shown initial promise in minimizing POD and POCD after non-neurological surgeries in observational studies.

 Our study aims to compare dexmedetomidine (intervention) with saline (control) administration during elective brain surgeries in adult patients (study population) with regards to the incidence of ED and POD (primary objectives), on the serum biomarkers of surgical stress, acute and chronic pain, POCD, and quality of life (secondary objectives).

 This prospective RCT will be conducted at NIMHANS, Bengaluru over a period of 36 months after approval from institute ethics committee and registration with Clinical Trial Registry of India. Our study population will include adult consenting patients undergoing elective brain surgeries under general anesthesia. We will exclude patients undergoing non-brain neurosurgeries, surgery performed with local anesthesia/sedation, having contraindications to dexmedetomidine (bradycardia, hypotension, heart block, arrhythmias), children (age 18 years), Glasgow Coma Scale (GCS) score 15, and refusal of consent.

 Cognitive Science Research Initiative, Department of Science & Technology (DST), Ministry of Science and Technology, Government of India