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

Abstract

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.

Brain relaxation using desflurane anesthesia and total intravenous anesthesia in patients undergoing craniotomy for supratentorial tumors: a randomized controlled study

“…Several studies have demonstrated propofol decrease ICP by reducing CBF and CBV simultaneously [ 19 , 20 ], while desflurane anesthesia dose-dependently increases ICP by promoting cerebral vasodilation [ 9 ]. However, no difference in brain relaxation among different anesthesia regimens has been demonstrated in several clinical trials [ 10 – 12 ]. It should be noted that these studies were not designed to investigate the effect of anesthesia regimens on brain relaxation and the routine use of mannitol may largely influence the evaluation of brain relaxation.…”

“…First, we did not supplement any objective measures to evaluate brain relaxation, such as subdural pressure and cerebrospinal fluid pressure monitoring, but only a subjective evaluation by the neurosurgeons. However, the standardized 4-point scale is the most practical and accessible measurement to evaluate brain relaxation, and it has been widely applied in many clinical studies [ 10 , 16 , 26 – 29 ]. Second, we only enrolled patients without severe intracranial hypertension, so the results cannot be extrapolated to patients with low cerebral compliance.…”

“…To our knowledge, there are few clinical trials designed to evaluate desflurane anesthesia and TIVA on brain relaxation during craniotomy. Most did not take brain relaxation as a primary endpoint and failed to fully address various factors that may influence brain relaxation, such as the use of mannitol [ 10 , 11 ]. Also, the sample size may be underpowered to discover the differences in brain relaxation between the two anesthesia regimens [ 12 ].…”

Propofol versus Desflurane in Moyamoya Disease Patients—A Pilot Study

“…16 However, clinical studies failed to demonstrate the neuroprotective effects of desflurane, but they did observe the hyperemic response. 17 18 These studies were conducted in supratentorial tumors and good-grade aneurysms with minimal disturbance in cerebral physiology. A retrospective study conducted in MMD also failed to find the difference in outcome using desflurane or propofol.…”

A Global Review of the Perioperative Care of Patients With Aneurysmal Subarachnoid Hemorrhage Undergoing Microsurgical Repair of Ruptured Intracerebral Aneurysm

“…This may imply institutional biases regarding locally preferred techniques versus what is supported by evidence. [16][17][18][19] Reported clinical practices and their alignment with available evidence deserve some discussion. Our survey results indicate that hypothermia is not routinely used for neuroprotection, which may be due to the results of the IHAST 20 clinical trial, and is also aligned with aSAH guidelines 2 which state that induced hypothermia during This study has some limitations as well as strengths.…”