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This chapter presents a case study of a 58-year-old female with multiple intact unsecured aneurysms, who presented for clipping of one paraclinoid aneurysm. Dexmedetomidine and nitrous oxide are commonly used as adjuvants to volatile agents or other intravenous anestheticsm. The case describes these agents in combination with each other for anesthetic maintenance of a cerebral aneurysm clipping. Hemodynamic stability was achieved both intraoperatively and postoperatively, preserving cerebral perfusion pressure and avoiding hypertension. Dexmedetomidine is unique in its ability to produce sedation, anxiolysis and analgesia with little respiratory depression. The hemodynamic stability associated with dexmedetomidine may also be cardioprotective. It becomes especially important when discussing an anesthetic agent in neurosurgery to examine its neurophysiologic profile. The combination of nitrous oxide and dexmedetomidine provided a complete anesthetic while maintaining hemodynamic stability, enabling neurophysiologic monitoring, and facilitating a prompt emergence in a patient with a history of delayed recovery from general anesthesia.
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