Propofol vs isoflurane for neurosurgical anesthesia in Thai patients.

Sixty Thai patients, ASA class I-II, Glasgow coma score of 15 undergoing elective intracranial surgery were randomly assigned to 2 groups. In group I, 30 patients were induced with thiopental 3-5 mg/kg, intubation with succinylcholine 1-2 mg/kg and then maintained with 60 per cent N2O in O2, isoflurane and vecuronium as a muscle relaxant. In group II, 30 patients received fentanyl 50 micrograms, propofol 1.0-2.5 mg/kg for induction and vecuronium 0.08 mg/kg for intubation then maintained with 60 per cent N2O in O2, continuous infusion of propofol 2-12 mg/kg/h and vecuronium as a muscle relaxant. Controlled ventilation in both groups was set to maintain PET CO2 in the range of 28-35 mmHg. 3 patients (1 in group I and 2 in group II) were excluded from the study due to surgical problems. There was no statistical difference in age, sex, ASA status, weight, duration of anesthesia. Group II had a more stable systolic BP, Diastolic BP and Pulse rate than Group I during induction and emergence from anesthesia. Glasgow coma scores in the recovery period, Group II had higher scores than Group I at 5 and 15 minutes but not at 30 minutes. Mean recovery times (eye opening) was 14.03 +/- 4.85 minutes in group I which is significantly different from 10 +/- 5.17 minutes in group II. The cost of anesthesia in group II was 1.3 times that of group I. In conclusion, although neurosurgical anesthesia for Thai patients with fentanyl-propofol technique produces more stable blood pressure during intubation and emergence, rapid recovery from anesthesia and a higher Glasgow coma score, the cost of anesthesia is more expensive. Furthermore, this technique is more difficult and needs more experience.

Effect of intraoperative fluid on blood glucose level in neurosurgery.

There is a considerable controversy regarding glucose administration during intracranial surgery. However, recent animal and human studies suggest that hyperglycemia exacerbates ischemic brain damage and intraoperative hypoglycemia may not be a concern if the surgical procedure is less than 4 hours. We, therefore, studied the blood glucose in neurosurgery with craniotomy in 90 Thai patients, divided into 3 groups. 30 patients in each group received balanced salt solution (0.9% NSS), 5 per cent glucose rate 60-80 ml/h and 5 per cent glucose rate more than 120 ml/h. Blood for the determination of glucose concentration was obtained after induction and every 2 hours later until the end of the surgery. There was one male patient in group I who received balanced salt solution (0.9% NSS) had blood glucose concentration lowered to 57 mg% at 4 hours after induction. The patients in group II who received 5 per cent glucose solution at maintenance rate did not have hyperglycemia (161.20 +/- 38.30 mg%). In group III; patients given 5 per cent glucose infusion at the rate of more than 120 ml/h had hyperglycemia (236.75 +/- 63.57 mg%) at 6 hours. In conclusion, we suggest that in Thai patients undergoing neurosurgical procedures; blood glucose levels should be checked intraoperatively if glucose is withheld from the intraoperative fluid regimen. Otherwise 80 ml/h of 5 per cent dextrose intravenous infusion should be given to the patients to prevent hypoglycemia.