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

Abstract

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.

Ventricular Tachycardia after Submucosal Infiltration of Lignocaine 2% with Adrenaline in Endoscopic Pituitary Surgery Under Desflurane Anesthesia

“…Infiltration with local anesthetic mixed with adrenaline is a common practice in endoscopic surgeries to provide better visualization and reduce blood loss and toxic effects of local anesthetic. 1 The nasal mucosa has propensity to absorb injected adrenaline and cause rapid rise in plasma concentrations to more than 10 times its normal plasma levels. 2…”

“…Short-acting inhalational and intravenous (IV) agents have been used successfully for this purpose, but desflurane offers the clinical advantage of rapid induction and recovery from anesthesia when compared to others. 1 This is desirable in patients undergoing endoscopic pituitary surgery that warrants quick recovery, minimal residual effects, and allows for early neurological assessment. 1 2…”

“…1 This is desirable in patients undergoing endoscopic pituitary surgery that warrants quick recovery, minimal residual effects, and allows for early neurological assessment. 1 2…”