effect of propofol-fentanyl versus sevoflurane-fentanyl on intracranial pressure and cerebral hemodynamics in surgeries for supratentorial mass lesions in children

ABSTRACT

This study was carried out to compare the effects of sevoflurane-fentanyl versus propofol-fentanyl anesthesia on cerebral hemodynamics and subdural intracranial pressure in children undergoing craniotomy for supratentorial tumors. Forty children, 3-8 years old, with supratentorial tumors resulting in midline shift of 5-10 mm were included in this prospective study. They were randomized into two equal groups. Anesthesia was induced with propofol, fentanyl and atracurium in both groups. In group S anesthesia was maintained with sevoflurane [1-1.5 MAC] in oxygen, while in group p anesthesia was maintained with a continuous intravenous infusion of propofol. Jugular venous bulb blood samples were obtained from a catheter introduced retrogradely into the right internal jugular vein. Intracranial pressure [ICP] was measured through a cannula inserted subdurally and connected via a fluid-filled tubing system to a pressure transducer. Cerebral perfusion pressure [CPP] and arterial- to-jugular venous oxygen difference [AJDO[2]] were calculated. The surgeon manually assessed dural tension prior to dural incision and also assessed the degree of brain swelling after dural incision. Observations were made during normocapnia and moderate hyperventilation. Anesthetic maintenance with propofol-fentanyl resulted in a significantly higher mean arterial pressure [MAP], significantly lower ICP, and significantly higher CPP [p<0.05 for all] compared to sevoflurane-fentanyl. On the other hand, jugular bulb venous oxygen saturation [SjvO[2]] was significantly higher and AJDO[2]] significantly lower in the group S [p<0.05]. Surgeon's assessment of dural tension and brain swelling was significantly more favorable in the group P [p<0.05]. The incidence of probable cerebral hypoperfusion or ischemia tended to be higher in group P but with no significant difference relative to group S. Propofol-fentanyl anesthesia seems to have more favorable effects on cerebral hemodynamics and intracranial pressure than sevoflurane fentanyl anesthesia in children undergoing craniotomy for supratentorial tumors, with no significant side effects on brain oxygenation