Comparison of propofol and desflurane for postanaesthetic morbidity in patients undergoing surgery for aneurysmal SAH: a randomized clinical trial

2020

Anesthesiology

Aneurysmal subarachnoid hemorrhage is an acute neurologic emergency. Prompt definitive treatment of the aneurysm by craniotomy and clipping or endovascular intervention with coils and/or stents is needed to prevent rebleeding. Extracranial manifestations of aneurysmal subarachnoid hemorrhage include cardiac dysfunction, neurogenic pulmonary edema, fluid and electrolyte imbalances, and hyperglycemia. Data on the impact of anesthesia on long-term neurologic outcomes of aneurysmal subarachnoid hemorrhage do not exist. Perioperative management should therefore focus on optimizing systemic physiology, facilitating timely definitive treatment, and selecting an anesthetic technique based on patient characteristics, severity of aneurysmal subarachnoid hemorrhage, and the planned intervention and monitoring. Anesthesiologists should be familiar with evoked potential monitoring, electroencephalographic burst suppression, temporary clipping, management of external ventricular drains, adenosine-induced cardiac standstill, and rapid ventricular pacing to effectively care for these patients.

Section: Management Of Aneurysmal Subarachnoid Hemorrhagementioning

confidence: 99%

Perioperative Management of Aneurysmal Subarachnoid Hemorrhage

2020

Anesthesiology

“…Although the short-term outcome with the use of propofol and desflurane has recently been studied, there are limited data regarding the effect of anesthetics on brain biochemical milieu and the long-term neurological outcome after surgery following aneurysmal SAH. [2,7] e purpose of the present trial was to determine whether we, as neuroanesthesiologists, by choosing suitable maintenance agents can influence longterm neurological outcomes after aneurysmal clipping surgery.…”

Section: Discussionmentioning

confidence: 99%

“…An RCT conducted on 70 patients assessing propofol and desflurane for postanesthetic morbidity in patients undergoing aneurysmal clipping found both to be comparable. [2] Length of postoperative hospital stay was taken as an indicator of short-term outcome in the above study. In our study, duration of hospital stay and mRS at discharge was comparable to this study, thereby indicating that both propofol and desflurane have a similar short-term outcome.…”

Section: Discussionmentioning

confidence: 99%

“…is study described the short-term outcome as regards to Glasgow Coma Scale (GCS) of the patient and the presence of any new neurological deficit 24 h following surgery. [2] Hoffman et al have compared the effects of etomidate and desflurane in patients undergoing middle cerebral artery occlusion for >15 min. In their study, tissue hypoxia and acidosis were observed during etomidate treatment.…”

mentioning

confidence: 99%

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Intravenous versus inhalational anesthesia trial for outcome following intracranial aneurysm surgery: A prospective randomized controlled study

Bhagat

Surgical Neurology International

Mahajan

et al. 2021

Self Cite

Background: For maintenance of anesthesia for intracranial aneurysmal neck clipping, both intravenous and inhalational anesthetics are in vogue. We aimed to evaluate the superiority of one agent over the other for long-term neurological outcomes in these patients. Methods: This prospective assessor-blind randomized study was conducted in 106 patients of 18–65 years of age with World Federation of Neurosurgeons Grade I-II of subarachnoid hemorrhage. After written informed consent, the patients were randomized into – intravenous group (Propofol) and inhalational group (Desflurane). The primary outcome was to study neurological outcome using Glasgow outcome scale (GOS) at 3 months following discharge while secondary outcomes included intraoperative brain condition, intraoperative hemodynamics, duration of hospital stay, Modified Rankin Score (MRS) at discharge, MRS, and Barthel’s index at 3 months following discharge and estimation of perioperative biomarkers of brain injury. Results: The GOS at 3 months was 5 (5.00–5.00) in the propofol group and 5 (4.00–5.00) in the desflurane group (P = 0.24). Both the anesthetics were similar in terms of intraoperative hemodynamics, brain relaxation, duration of hospital stay, MRS at discharge and 3 months, and Barthel Index at 3 months (P > 0.05). The perioperative serum interleukin-6 and S100B were comparable among the groups (P > 0.05). Conclusion: The long-term neurological outcome of good grade aneurysm patients undergoing craniotomy and clipping remains comparable with the use of either propofol or desflurane. The effect of the two anesthetic agents on the various clinical parameters and the biomarkers of brain injury is also similar.

“…also found identical brain relaxation scores using entropy guided maintenance dose of propofol and desflurane in patients undergoing surgery for aSAH. [ 4 ] However, it would be interesting to study the effect of burst suppression induced at the time of clipping of aneurysm on POCD.…”

Section: Discussionmentioning

confidence: 99%

Comparison of postoperative cognitive dysfunction with the use of propofol versus desflurane in patients undergoing surgery for clipping of aneurysm after subarachnoid hemorrhage

Surgical Neurology International

Wig

Mahajan

et al. 2020

Self Cite

Background: Cerebral aneurysm rupture is a distinct entity among various causes of cerebrovascular accident. Despite the current concept of early surgical clipping to prevent consequences of ruptured aneurysm in good grade subarachnoid hemorrhage patients, 40–50% have postoperative cognitive dysfunction (POCD) on a long- term basis. Here, we compared the effect of two commonly used anesthetic agents on cognitive function following cerebral aneurysmal surgery, i.e., propofol and desflurane. Methods: We conducted a prospective double-blind clinical study in 70 patients who were randomized to receive maintenance anesthetic agents either propofol or desflurane. The cognitive functions of patients were studied at the time of the discharge from a hospital or at 2 weeks following surgery whichever was early using the Hindi version of the Montreal Cognitive Assessment scale. The hemodynamic parameters, brain relaxation score at the different time intervals, were also studied. Results: There was no difference between the two anesthetic agents in terms of incidence of POCD (65.4% vs. 82.6%, P > 0.05) at the time of discharge or at 2 weeks following surgery. The mean POCD score in propofol and desflurane group was 22.81 ± 4.45 and 19.09 ± 5.66 which was statistically significant (P-value-0.01). The scores for domains of executive function, attention, and orientation were better with propofol group than desflurane group. Intraoperative hemodynamics and brain relaxation scores were similar in both groups. Conclusion: A significant number of patients undergoing aneurysmal neck surgery experienced POCD although incidence remained similar in both groups. However, it appears that mean cognitive score and certain domains of cognitive functions especially the executive function, attention, and orientation were better preserved with the use of propofol when compared to desflurane at the time of discharge or on 2 weeks following surgery whichever was early.