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

Abstract

Purpose:General anesthesia causes inhibition of thermoregulatory mechanisms. Propofol has been reported to cause more temperature fall, but in case of deliberate mild hypothermia, both sevoflurane and propofol were comparable. Thermoregulation is found to be disturbed in cases of pituitary tumors. We aimed to investigate which of the two agents, sevoflurane or propofol, results in better preservation of thermoregulation in patients undergoing transsphenoidal excision of pituitary tumors.Methods:Twenty-six patients scheduled to undergo transsphenoidal removal of pituitary adenomas were randomly allocated to receive propofol or sevoflurane anesthesia. Baseline esophageal temperature was noted. Times for temperature to fall by 1°C or 35°C and to return to baseline were also comparable (P>0.05). After that warmer was started at 43°C and time to rise to baseline was noted. Duration of surgery, total blood loss, and total fluid intake were also noted. If any, side effects such as delayed arousal and recovery from muscle relaxant were noted.Results:The demographics of the patients were comparable. Duration of surgery and total blood loss were comparable in the two groups. The time for temperature to fall by 1°C or 35°C and time to return to baseline was also comparable (P>0.05). No side effects related to body temperature were noted.Conclusion:Both propofol and sevoflurane show similar effects in maintaining thermal homeostasis in patients undergoing transsphenoidal pituitary surgery.

Effects of anesthetics on post‐operative 3‐month neuroendocrine function after endoscopic transsphenoidal non‐functional pituitary adenoma surgery

“…Sixth, we did not compare clinically important outcomes, such as intraoperative hemodynamics and recovery profiles from anesthesia, between sevoflurane and propofol groups. However, previous studies showed no clinically significant differences in terms of perioperative hemodynamics, intraoperative thermoregulation and blood loss, time to extubation, length of stay in the post‐anesthesia recovery room, and operating conditions between sevoflurane and propofol anesthesia for ETS 23‐27 . Lastly, the non‐inferiority margin was as high as 9% in this study.…”

Total intravenous versus inhaled anesthesia in transsphenoidal tumor surgery

“…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.…”

“…A power analysis based on Chowdhury et al 18 revealed a sample size of 45 patients per group to find a clinically relevant decrease in EBL of 25% with a power of 80%. After approval by the Institutional Review Board of the Medical College of Wisconsin (MCW), we conducted a retrospective chart analysis of 193 American Society of Anesthesiologists (ASA) class 1 to 3 patients who had undergone transsphenoidal, endonasal resections of pituitary tumors at MCW over a seven-year time period.…”

Intraoperative Rise of Surface Temperature Monitors Success of Sympathectomy in Palmoaxillary Hyperhidrosis

“…The investigations performed by Kwak et al support this decision in that body temperature did not differ when using the two types of anesthesia mentioned above [12]. Although Propofol has been reported to cause a lower body temperature in comparison to narcotic gases they were comparable in conditions of mild perioperative hypothermia [13].…”