The effects of sevoflurane and propofol on cerebral hemodynamics during intracranial tumors surgery under monitoring the depth of anesthesia

Abstract

Hemodynamic effects during cerebral tumor resection surgery under monitoring the depth of anesthesia and during recovery in sevoflurane- or propofol-anesthetized patients have not been previously compared. Objective. To compare cerebral hemodynamic changes using transcranial Doppler sonography during sevoflurane or propofol anesthesia under state entropy (SE) monitoring, and during recovery period. Material and methods. In a randomized manner, 130 patients received sevoflurane (group T-S) or propofol (group T-P) to maintain SE at 40–50. Cerebral blood flow velocity (Vmean) in the middle cerebral artery was evaluated at baseline, after tracheal intubation, opening of the dura mater, tumor resection, skin closure, extubation, and two hours after extubation. Cerebrovascular resistance index (RAP), estimated cerebral perfusion pressure (eCPP), and cerebral blood flow index (CBFI) were calculated off-line. Results. During surgery SE was 40.6 (SD, 8.1) in the group T-S and 44.0 (SD, 7.4) in the group T-P. Blood pressure was significantly higher in the group T-P. Compared to the baseline, Vmean decreased by 16.6% and 23.5% in the groups T-S and T-P, respectively (P<0.05). RAP and eCPP were higher in the group T-P versus the group T-S: 28.9% and 5.2%, respectively, above the baseline for RAP (P<0.005) and 3.2% and 16.9% below the baseline for eCPP (P<0.005). CBFI was below the baseline by 20.1% and 24.0% in the groups T-S and T-P, respectively (P>0.05). After the extubation and 2 hours later, Vmean recovered comparably with no differences in RAP, eCPP, or CBFI between the two groups. Conclusions. At the comparable depth of anesthesia for intracranial tumors surgery and during recovery, sevoflurane had no major effect on cerebral circulation measured by transcranial Doppler sonography as compared with propofol. Our results add to current knowledge on the safety of sevoflurane in neuroanesthesia.

Volatile sedation with sevoflurane in intensive care patients with acute stroke or subarachnoid haemorrhage using AnaConDa®: an observational study

“…As a result, the safety and feasibility of sevoflurane for sedation in the NCCU is unclear. [3][4][5][6][7][8][9][10] With a more widespread administration of sevoflurane to ICU patients with primary or secondary brain injury, potential benefits as well as harms might go unnoticed if multimodality neuromonitoring is not utilized. To clarify the potential benefits and safety concerns regarding sevoflurane sedation, we prospectively analysed the switch from i.v.…”

Intravenous versus inhalational techniques for rapid emergence from anaesthesia in patients undergoing brain tumour surgery: A Cochrane systematic review

“…We included 15 studies in our review [ Figure 3]. [2][3][4]6,15,[22][23][24][25][26][27][28][29][30][31] All included studies were of parallel design. Propofol was the intravenous anaesthetic agent used in all studies except one, in which thiopentone sodium was used.…”

“…Propofol was the intravenous anaesthetic agent used in all studies except one, in which thiopentone sodium was used. [28] Isoflurane was the inhalational anaesthetic agent used in five studies, [4,6,[27][28][29] sevoflurane was used in eight studies [2,3,[23][24][25][26]30,31] and both sevoflurane and isoflurane were used in two studies. [15,22] We retrieved no studies in which enflurane, halothane and desflurane were used in the control group.…”

“…Of the 15 included studies, only seven [2,4,6,15,22,23,31] reported allocation concealment. The remaining studies did not describe or did not perform allocation concealment.…”

“…Among the 15 included studies, we observed performance bias in six studies, [2,4,6,24,26,27] but the other studies did not report it. We noted detection bias in four studies [4,6,22,27] and found uncertain risk in four studies, [23,24,28,29] as they did not describe or perform blinding of outcome assessment.…”