Bispectral Index-guided Administration of Anesthesia for Transsphenoidal Resection of Pituitary Tumors

Abstract

The main aims of anesthesia for pituitary surgery include maintenance of hemodynamic stability, provision of conditions that facilitate surgical exposure, and a smooth emergence to facilitate a prompt neurologic assessment. The primary aim of our study was to compare the effects of 3 anesthetic regimens on hemodynamics and recovery characteristics of the patients. Ninety patients undergoing transsphenoidal surgery were enrolled in the study. Standard anesthesia technique was followed for induction. Patients were randomly divided to receive propofol, isoflurane, or sevoflurane for maintenance of anesthesia. The bispectral index target range during maintenance was 40 to 60. The hemodynamic variables (heart rate and mean arterial pressure) and bispectral index were noted during the various stages of the surgery. The time to emergence and extubation was noted. We evaluated cognitive function at 5 and 10 minutes posttracheal extubation. The 3 study groups were comparable with respect to age, sex, weight, and duration of surgery. We observed an increase in heart rate and blood pressure during intubation, nasal packing, and insertion of self-retaining nasal speculum. After tracheal intubation, the rise in blood pressure was more in sevoflurane group than propofol. During emergence, hypertensive response was seen in all patients. Emergence and extubation times were significantly shorter with propofol and sevoflurane. Patients who received propofol had better cognition scores. Aldrete scores were better with propofol and sevoflurane than isoflurane. The pressor response after intubation and emergence hypertension was significantly less with propofol. Better recovery profile was seen in sevoflurane and propofol groups and a better cognition in patients receiving propofol. Propofol plus nitrous oxide anesthesia could be the technique of choice in patients undergoing transnasal transsphenoidal pituitary surgery.

Total intravenous versus inhaled anesthesia in transsphenoidal tumor surgery

“…Though TIVA was found feasible and safe, 32,33 there was no evidence of decreased blood loss, only a slightly faster wakeup with sevoflurane vs propofol when remifentanil was used in both groups. 34 Other studies found no difference in wake-up between sevoflurane and propofol, but did not assess 35 or found no difference in blood loss between the groups. 18 There was also no difference in the severity of stress response during pituitary surgery between TIVA and sevoflurane/N 2 O inhaled anesthesia.…”

“…36 Consequently, pertinent review articles on perioperative management of patients undergoing endoscopic transsphenoidal surgery do not recommend one particular anesthetic technique over another, 1–4 as long as a reasonably rapid recovery for timely postoperative neurological assessment is facilitated 3,4 for which shorter acting volatile anesthetics or propofol appear to have an advantage over isoflurane. 35 …”

Comparison of propofol versus sevoflurane on thermoregulation in patients undergoing transsphenoidal pituitary surgery: A preliminary study

“…However, the increase in core temperature is not affected by vasodilatation by anesthetics. [11] Ali and colleagues reported that propofol in comparison to inhalational agents, is a better anesthetic agent due to the lesser pressor response after intubation, less emergence hypertension, and better cognitive function, in patients undergoing transsphenoidal pituitary surgery,[12] but for maintaining thermal balance of body, sevoflurane is not better than propofol.…”

Comparative evaluation of atenolol and clonidine premedication on cardiovascular response to nasal speculum insertion during trans-sphenoid surgery for resection of pituitary adenoma: A prospective, randomised, double-blind, controlled study

“…[1] Increased bleeding due to this haemodynamic response obscures microscopic details of the sellar region. [2]…”