Intravenous versus inhalational techniques for rapid emergence from anaesthesia in patients undergoing brain tumour surgery

Background Dexmedetomidine is widely used in the treatment of emergency delirium (ED) in pediatric patients. However, further evidence on its use in pediatric anesthesia on potential differences in the reduction of ED according to patient’s age and type of anesthesia is required. Moreover, whether dexmedetomidine influences time of discharge from the surgical area remains unclear. We evaluated whether intranasal dexmedetomidine is effective in decreasing the incidence of ED in 106 children who had anesthesia for plastic surgery undergoing general or combined anesthesia at different ages. We also assessed if this drug has an impact on time to discharge from the surgical area. Methods In total, 106 children, aged 2–10 years, were enrolled in this retrospective study. Among them, 50 have been premedicated with dexmedetomidine (dexmedetomidine group); the remaining 56 patients served as controls (control group). The incidence of ED was evaluated according to the use of dexmedetomidine premedication, age and type of anesthesia (general vs combined). The length of anesthesia and duration of staying in the surgical area were also analyzed. Results Three patients who received dexmedetomidine premedication showed ED (6%), compared with 43 patients in the control group (77%; p<0.05). This lower incidence of ED was also present when stratifying patients according to the type of anesthesia or age. No difference between the dexmedetomidine group and control group were reported in timing of discharge from surgical area.Conclusions Premedication with dexmedetomidine is associated with decreased incidence of ED without increasing timing of discharge after surgery, regardless of patients’ age or type of anesthesia. In particular, patients subjected to combined anesthesia report benefit from the use of this molecule.

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“…The Aldrete scale was used to determine whether the child could be discharged [21], with scores >9 indicative of possible discharge.…”

Section: Methodsmentioning

confidence: 99%

Emergence delirium and intranasal dexmedetomidine premedication in pediatric anesthesia: a retrospective study in plastic surgery

Palma

Maldarelli

Cimino

et al. 2019

Preprint

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“…Both inhalational and intravenous agents have been used for anesthesia in neurosurgical patients. [1][2][3] However, neither is clearly superior to other under most circumstances. Endoscopic pituitary surgery is a short surgery and quick recovery from anesthesia is desirable.…”

Section: Introductionmentioning

confidence: 94%

Comparison of Bispectral Index-Guided Administration of Desflurane and Propofol for Endoscopic Transnasal Transsphenoidal Resection of Pituitary Tumors

Bharadwaj

Mahajan

Aggarwal

et al. 2020

Journal of Neuroanaesthesiology and Critical Care

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Background Use of short-acting anesthetic agents such as propofol and desflurane allows rapid awakening and prompt neurological assessment of patients undergoing endoscopic transnasal transsphenoidal resection of pituitary tumors. However, there are no studies comparing the effect of these two agents in these patients. We performed this study to compare the intraoperative hemodynamics and postoperative recovery characteristics of patients undergoing endoscopic transnasal transsphenoidal (TNTS) pituitary tumor surgery using bispectral index (BIS)-guided administration of desflurane and propofol. Materials and Methods In this prospective, randomized trial, 60 patients undergoing endoscopic TNTS pituitary surgery were randomized to receive BIS-guided administration of either propofol (Group P) or desflurane (Group D) for the maintenance of anesthesia. Heart rate (HR), mean arterial pressure (MAP), intraoperative complications, time to emergence, extubation, cognition, and modified Aldrete score were evaluated. Statistical analysis was performed using STATA 12.0. Categorical and continuous variables were compared between the groups using Fisher’s exact test and t-test, respectively. Emergence from anesthesia and hemodynamics at various stages of surgery was compared between the groups using Wilcoxon rank sum test. The p-value < 0.05 was considered statistically significant. Results The HR was significantly higher at all stages of surgery in group P (p = 0.01). MAP was comparable between the groups at various time points (p > 0.05). Both emergence time (8.5 vs. 15 minutes; p < 0.00) and extubation time (10 vs. 17.5 minutes; p < 0.00) were significantly shorter in Group D compared with Group P. Modified Aldrete score at 5 and 10 minutes after extubation was higher with desflurane than propofol, but early cognition was comparable between the two groups. Conclusion The hemodynamics and early cognition score were comparable in patients receiving propofol or desflurane. Desflurane provides rapid emergence and recovery when compared with propofol.

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“…Intraoperative brain relaxation, which will be scored by the neurosurgeons after opening the cranium and before opening the dura. They will use a 4-point scale [22]: 1, completely relaxed; 2, satisfactorily relaxed; 3, firm brain; 4, bulging brain. 6.…”

Section: Study Objective Primary and Secondary Outcomesmentioning

confidence: 99%

The effects of protective lung ventilation on regional cerebral oxygen saturation in intracranial tumor operation during dura opening: study protocol for a randomized controlled trial

Liu

et al. 2020

Trials

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Objective: The objective of this trial is to investigate the effects of protective lung ventilation on regional cerebral oxygen saturation (rSO 2 ) during dura opening, that is from Ta (after dura opening) to Tb (before dura closing), in patients undergoing intracranial tumor surgery. Methods: This is a randomized controlled trial which will be carried out at the Second Affiliated Hospital of Soochow University. Fifty-four patients undergoing intracranial tumor surgery will be randomly allocated to the control group (C group) or the protective lung ventilation group (P group). In the C group, the tidal volume (VT) will be set at 8 ml/kg of predicted body weight, but positive end-expiratory pressure (PEEP) and recruitment maneuvers will not be used. In the P group, VT will be set at 6 ml/kg of predicted body weight combined with individualized PEEP during dura opening, while in other periods of general anesthesia, VT will be set at 8 ml/kg of predicted body weight. The level of rSO 2 , partial pressures of oxygen and carbon dioxide, oxygenation index, lactic acid level in arterial blood, and mean arterial pressure will be compared before anesthesia (T0), before dura opening (T1), after dura closing (T2), and 24 h after surgery (T3). Lung ultrasound scores will be measured at T0 and T3. The degree of brain relaxation at T1 and T2 will be evaluated by the surgeon using the brain relaxation scale. The amount of vasoactive drugs used and blood loss will be recorded during surgery. The duration of operation and reoperation rate will be recorded. The primary outcome of this study is the changes in rSO 2 within 24 h postoperatively.Discussion: This study aims to determine whether protective lung ventilation during dura opening can improve rSO 2 and the state of pulmonary ventilation in patients undergoing intracranial tumor surgery, and to investigate whether this strategy affects the degree of brain tissue swelling and the reoperation rate after operation. If our results are positive, this study will show that protective lung ventilation during dura opening can be used effectively and safely in neurosurgical patients undergoing craniotomy for tumor resection.

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Intravenous versus inhalational techniques for rapid emergence from anaesthesia in patients undergoing brain tumour surgery

Abstract: Intravenous versus inhalational techniques for rapid emergence from anaesthesia in patients undergoing brain tumour surgery (Review)

Cited by 31 publications

References 34 publications

Emergence delirium and intranasal dexmedetomidine premedication in pediatric anesthesia: a retrospective study in plastic surgery

Emergence delirium and intranasal dexmedetomidine premedication in pediatric anesthesia: a retrospective study in plastic surgery

Comparison of Bispectral Index-Guided Administration of Desflurane and Propofol for Endoscopic Transnasal Transsphenoidal Resection of Pituitary Tumors

The effects of protective lung ventilation on regional cerebral oxygen saturation in intracranial tumor operation during dura opening: study protocol for a randomized controlled trial

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