Comparison of total intravenous anesthesia vs. inhalational anesthesia on brain relaxation, intracranial pressure, and hemodynamics in patients with acute subdural hematoma undergoing emergency craniotomy: a randomized control trial

Preethi, Jayakumar; Bidkar, Prasanna Udupi; Cherian, Anusha; Dey, Aparajita; Swaminathan, Srinivasan; Adinarayanan, S; Ramesh, A

doi:10.1007/s00068-019-01249-4

Cited by 25 publications

(12 citation statements)

References 21 publications

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“…Second, the impact of different anesthesia regimens on brain relaxation may be associated with the patient's intracranial status. Preethi et al[ 21 ]. reported that TIVA is superior to inhalational anesthesia (isoflurane) in providing brain relaxation in patients with severe traumatic brain injury.…”

Section: Discussionmentioning

confidence: 99%

Brain relaxation using desflurane anesthesia and total intravenous anesthesia in patients undergoing craniotomy for supratentorial tumors: a randomized controlled study

Jiang

Liang

et al. 2023

BMC Anesthesiol

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Background Satisfactory brain relaxation is essential in neurosurgery. Desflurane anesthesia and propofol-based total intravenous anesthesia (TIVA) have different effects on cerebral hemodynamics, potentially contributing to discrepant brain relaxation. The purpose of this study was to compare the effects of desflurane and TIVA on brain relaxation in patients undergoing craniotomy for supratentorial tumors. Methods In this randomized, controlled study, we enrolled patients aged 18–60 years, with ASA I–III, who were scheduled to undergo elective craniotomy for supratentorial tumors. Patients were randomly assigned in a 1:1 ratio to receive desflurane anesthesia or TIVA. The primary outcome was the proportion of satisfactory brain relaxation. Secondary outcomes included emergence and extubation times, recovery of cognitive function and postoperative complications. Results Of 369 patients who were assessed for eligibility, 111 were randomized and 110 were included in the modified intention-to-treat analysis (55 in the desflurane group and 55 in the TIVA group). The proportion of satisfactory brain relaxation was similar between the two groups: 69% in the desflurane group and 73% in the TIVA group (RR: 0.950, 95% CI: 0.748–1.207; P = 0.675). Patients assigned to the desflurane group had shorter emergence (10 [8–13] min vs. 13 [10–20] min, P < 0.001) and extubation times (13 [10–18] min vs. 17 [13–23] min, P < 0.001), and better recovery of cognitive function at 15 min after extubation (16 [0–24] vs. 0 [0–20], P = 0.003), but experienced increased postoperative nausea and vomiting (PONV) (16 [29%] vs. 6 [11%] P = 0.017) and tachycardia (22 [40%] vs. 9 [16%], P = 0.006) during recovery. Conclusions Desflurane anesthesia and TIVA provide similar brain relaxation in patients without intracranial hypertension undergoing elective craniotomy. Desflurane accelerates the recovery from anesthesia but is associated with increased PONV and tachycardia during the recovery period. Trial registration Clinicaltrial.gov (NCT04691128). Date of registration: December 31, 2020.

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Section: Discussionmentioning

confidence: 99%

Brain relaxation using desflurane anesthesia and total intravenous anesthesia in patients undergoing craniotomy for supratentorial tumors: a randomized controlled study

Jiang

Liang

et al. 2023

BMC Anesthesiol

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“…13 Inhalational anesthetics have a direct cerebral vasodilator effect that increases the cerebral blood volume and dose-dependently increases ICP. In contrast, propofol and opioids have little effect on the ICP 14,15 ; therefore, in this study, continuous infusion of propofol and remifentanil was used to reduce the possibility of anesthesia-induced ICP increase.…”

Section: Anesthesiamentioning

confidence: 99%

Detection of increased intracranial pressure in trans‐oral robotic thyroidectomy using optic nerve sheath diameter measurement

Lim

Kim

et al. 2022

Head & Neck

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Background During transoral robot‐assisted thyroidectomy, there is a risk of increasing intracranial pressure because the site of CO2 insufflation is narrow and close to the brain. Methods We analyzed the pre‐ to post‐CO2 neck insufflation change in the optic nerve sheath diameter during transoral robot‐assisted thyroidectomy. Changes in vital‐signs, airway pressure, and arterial carbon dioxide pressure were analyzed along with postoperative complications. Results Among the 30 participants, the post‐CO2 inflation mean optic nerve sheath diameter (5.64 ± 0.54 mm) was higher than the pre‐induction diameter (4.81 ± 0.37 mm) with a mean difference of 0.83 (95% CI, 0.69–0.97; p < 0.001), but returned to baseline after CO2 deflation in most cases. One participant had sustained increased optic nerve sheath diameter (6.35 mm) associated with severe new‐onset postoperative headache. Conclusion Transient elevation in the intracranial pressure during low‐pressure CO2 neck insufflation in the transoral robot‐assisted thyroidectomy did not appear to adversely affect patients.

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“…More recently, studies demonstrated improved outcomes when TIVA is used [42], whereas other studies have not shown a significant difference between TIVA versus inhalational agents in MMD [43]. Many centers are routinely utilizing total intravenous anesthesia (TIVA) with target-controlled infusion (TCI) of propofol and opioids (remifentanil) for the neurosurgical procedure [44]. In TCI, the infusion pumps are set to deliver a bolus on induction followed by a maintenance infusion based on the patient's demographics.…”

Section: Choice Of Anesthesia Techniquesmentioning

confidence: 99%

Perioperative Considerations for Revascularization and Non-Revascularization Surgeries in Moyamoya Disease

Khan¹,

Hassan²,

Aboobacker³

et al. 2021

Moyamoya Disease - A Disease to Count on in Your Daily Practice

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Moyamoya disease is a rare, progressive cerebrovascular occlusive disease; characterized by narrowing of the distal internal carotid arteries and their branches. The incidence is high in East Asians and most commonly presents in the first and fourth decade of life. Its symptoms are headaches, seizures, transient neurological deficits, and cognitive decline. Medical management is based on treating the symptoms and includes antiplatelet and anti-seizure medications. Surgical revascularization is the mainstay of treatment. Unique pathophysiology of moyamoya disease necessitates neuro-anesthesiologists to formulate an individualized plan perioperatively. The overriding goal of perioperative anesthetic management of moyamoya disease is to ensure optimal cerebral perfusion and protection. Maintenance of normotension, normocarbia, normo-oxygenation, normothermia, and euvolemia is the cornerstone during the perioperative period. Perioperative adequate analgesia is crucial to prevent cerebral ischemia and allows close neurological monitoring. This chapter reviews perioperative anesthetic management of patients with moyamoya disease.

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Comparison of total intravenous anesthesia vs. inhalational anesthesia on brain relaxation, intracranial pressure, and hemodynamics in patients with acute subdural hematoma undergoing emergency craniotomy: a randomized control trial

Cited by 25 publications

References 21 publications

Brain relaxation using desflurane anesthesia and total intravenous anesthesia in patients undergoing craniotomy for supratentorial tumors: a randomized controlled study

Brain relaxation using desflurane anesthesia and total intravenous anesthesia in patients undergoing craniotomy for supratentorial tumors: a randomized controlled study

Detection of increased intracranial pressure in trans‐oral robotic thyroidectomy using optic nerve sheath diameter measurement

Perioperative Considerations for Revascularization and Non-Revascularization Surgeries in Moyamoya Disease

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