ABSTRACT
Post operative recovery has been reported to be faster with desflurane than sevoflurane anesthesia in previous studies. The use of desflurane is often criticized in neurosurgery due to the concerns of cerebral vasodilation and increase in ICP and studies comparing desflurane and sevoflurane in neurosurgey are scarce. So we compared the intraoperative brain condition, hemodynamics and postoperative recovery in patients undergoing elective supratentorial craniotomy receiving either desflurane or sevoflurane. Fifty three patients between 18-60yr undergoing elective supratentorial craniotomy receiving N[2] O and oxygen [60%:40%] and 0.8-1.2 MAC of either desflurane or sevoflurane were randomized to group S [Sevoflurane] or group D [Desflurane]. Subdural intra cranial pressure [ICP] was measured and brain condition was assessed. Emergence time, tracheal extubation time and recovery time were recorded. Cognitive behavior was evaluated with Short Orientation Memory Concentration Test [SOMCT] and neurological outcome [at the time of discharge] was assessed using Glasgow Outcome Score [GOS] between the two groups. The emergence time [Group D 7.4 +/- 2.7 minutes vs. Group S 7.8 +/- 3.7 minutes; P = 0.65], extubation time [Group D 11.8 +/- 2.8 minutes vs. Group S 12.9 +/- 4.9 minutes; P = 0.28] and recovery time [Group D 16.4 +/- 2.6 minutes vs. Group S 17.1 +/- 4.8 minutes; P = 0.50] were comparable between the two groups. There was no difference in ICP [Group D; 9.1 +/- 4.3 mmHg vs. Group S; 10.9 +/- 4.2 mmHg; P = 0.14] and brain condition between the two groups. Both groups had similar post-operative complications, hospital and ICU stay and GOS. In patients undergoing elective supratentorial craniotomy both sevoflurane and desflurane had similar intra-operative brain condition, hemodynamics and post operative recovery profile
Subject(s)
Humans , Female , Arrhythmias, Cardiac , Valsalva Maneuver , Fourth Ventricle , Heart VentriclesABSTRACT
Re-intubation of neurosurgical patients after a successful tracheal extubation in the operating room is not uncommon. However, no prospective study has ever addressed this concern. This study was aimed at analyzing various risk factors of re-intubation and its effect on patient outcome. Patients aged between 18-60 years and of ASA physical status 1 and 2 undergoing elective craniotomies over a period of two years were included. A standard anesthetic technique using propofol, fentanyl, rocuronium, and isoflurane/sevoflurane was followed, in all these patients. 'Re-intubation' was defined as the necessity of tracheal intubation within 72 hrs of a planned extubation. Data were collected and analyzed employing standard statistical methods. One thousand eight hundred and fifty patients underwent elective craniotomy, of which 920 were included in this study. A total of 45 [4.9%] patients required re-intubation. Mean anesthesia duration and time of re-intubation were 6.3 +/- 1.8 and 24.6 +/- 21.9 hrs, respectively. The causes of re-intubation were neurological deterioration [55.6%], respiratory distress [22.2%], unmanageable respiratory secretion [13.3%], and seizures [8.9%]. The most common post-operative radiological [CT scan] finding was residual tumor and edema [68.9%]. Seventy-three percent of the re-intubated patients had satisfactory post-operative cough-reflex. The ICU and hospital stay, and Glasgow outcome scale at discharge were not significantly affected by different causes of re-intubation. Neurological deterioration is the most common cause of re-intubation following elective craniotomies owing to residual tumor and surrounding edema. A satisfactory cough reflex may not prevent subsequent re-intubation in post-craniotomy patients
Subject(s)
Humans , Male , Female , Craniotomy , Prospective Studies , Airway Extubation , Tomography, X-Ray Computed , CoughABSTRACT
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. 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[degree sign] C or 35[degree sign] C and to return to baseline were also comparable [P>0.05]. After that warmer was started at 43[degree sign] 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. 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[degree sign] C or 35[degree sign] C and time to return to baseline was also comparable [P>0.05]. No side effects related to body temperature were noted. Both propofol and sevoflurane show similar effects in maintaining thermal homeostasis in patients undergoing transsphenoidal pituitary surgery