[Comparison of anesthetic maintenance and recovery with propofol versus sevoflurane combined with remifentanil in craniotomy for supratentorial neoplasm]. / Estudio comparativo de remifentanilo combinado con propofol o sevofluorano para el mantenimiento y recuperación de la anestesia en craneotomía por neoplasia supratentorial.

OBJECTIVE: To compare the effectiveness of propofol versus sevoflurane associated with remifentanil on the maintenance of anesthesia and on recovery in patients undergoing elective supratentorial craniotomy. PATIENTS AND METHODS: Prospective randomized trial enrolling 90 patients scheduled for excision of a brain neoplasm. All received an infusion of remifentanil at a dose of 0.5 microg x Kg(-1) x min(-1) until tracheal intubation and then 0.25 microg x Kg(-1) x min(-1) during surgery. Induction was achieved with propofol and anesthesia was maintained with either sevoflurane at a maximum alveolar concentration of 0.4 (45 patients) or propofol by target controlled infusion at a concentration of 2.5 microg x mL(-1) (45 patients, group P). Variables assessed were hemodynamic stability during anesthesia and times and quality of recovery from anesthesia (eye opening, initiation of spontaneous ventilation, extubation, cough reflex, and temporal and spacial orientation 3 minutes after extubation. During the first 24 hours after surgery, pain intensity was evaluated on a verbal visual analog scale (VAS) and the incidence of nausea and vomiting was recorded. RESULTS: Times until eye opening upon request and until extubation were significantly shorter in the sevoflurane group than in the propofol group: 3.7 (SD, 1.2) minutes vs 5 (3.1) minutes, respectively, for eye opening and 6.6 (1.2) minutes vs 8.1 (3.3) minutes for extubation (P<0.01). The incidence of nausea and vomiting was significantly higher in the sevoflurane group (40% vs 13%, respectively, P<0.01). CONCLUSIONS: Combining remifentanil with propofol or with sevoflurane provides satisfactory anesthesia during elective supratentorial craniotomy to remove a brain neoplasm. Hemodynamic stability is appropriate and recovery from anesthesia is rapid.

Estudio comparativo de remifentanilo combinado con propofol o sevofluorano para el mantenimiento y recuperación de la anestesia en craneotomía por neoplasia supratentorial / Comparison of anesthetic maintenance and recovery with propofol versus sevoflurane combined with remifentanil in craniotomy for supratentorial neoplasm

OBJETIVO. Comparar el uso de propofol o sevofluoranoasociados a remifentanilo para el mantenimiento yrecuperación de la anestesia en pacientes sometidos acraneotomía supratentorial electiva.PACIENTES Y MÉTODOS. Estudio prospectivo y aleatoriosobre 90 pacientes programados para exéresis deneoplasia cerebral. Todos recibieron remifentanilo a 0,5µg Kg-1 min-1 hasta la intubación traqueal seguido de0,25 µg Kg-1 min-1 durante la cirugía. Inducción con propofoly mantenimiento con sevoflurano 0,4 CAM (45pacientes, grupo S) o propofol con TCI (target controlinfusion) a 2,5 µg mL-1 (45 pacientes, grupo P). Se valoróla estabilidad hemodinámica durante la anestesia, lostiempos y calidad de la recuperación tras la anestesia:apertura de los ojos, inicio de la ventilación, extubación,capacidad para toser y orientación temporoespacial a los3 minutos de la extubación. Durante las primeras 24horas del postoperatorio se evaluó la intensidad deldolor mediante la escala de valoración verbal (EVS) y seregistró la incidencia de náuseas y vómitos (NVPO).RESULTADOS. Los tiempos de apertura de los ojos pororden y de extubación fueron significativamente menoresen el grupo S (3,7 ± 1,2 min frente 5 ± 3,1 min y 6,6± 1,2 min frente 8,1 ± 3,3 min (p<0,01 respectivamente).La incidencia de NVPO fue significativamente superioren el grupo S (40% frente 13%, p<0,01).CONCLUSIONES. La combinación de remifentanilo conpropofol o con sevoflurano proporcionan una anestesiasatisfactoria durante la craneotomía supratentorial electivapor neoplasia cerebral, consiguiendo la estabilidadhemodinámica apropiada y la recuperación rápida de laanestesia

OBJECTIVE: To compare the effectiveness of propofolversus sevoflurane associated with remifentanil on themaintenance of anesthesia and on recovery in patientsundergoing elective supratentorial craniotomy.PATIENTS AND METHODS: Prospective randomized trialenrolling 90 patients scheduled for excision of a brainneoplasm. All received an infusion of remifentanil at adose of 0.5 µg·Kg-1·min-1 until tracheal intubation andthen 0.25 µg·Kg-1·min-1 during surgery. Induction wasachieved with propofol and anesthesia was maintainedwith either sevoflurane at a maximum alveolar concentrationof 0.4 (45 patients) or propofol by target controlledinfusion at a concentration of 2.5 µg·mL-1 (45patients, group P). Variables assessed were hemodynamicstability during anesthesia and times and qualityof recovery from anesthesia (eye opening, initiation ofspontaneous ventilation, extubation, cough reflex, andtemporal and spacial orientation 3 minutes after extubation.During the first 24 hours after surgery, pain intensitywas evaluated on a verbal visual analog scale (VAS)and the incidence of nausea and vomiting was recorded.RESULTS: Times until eye opening upon request anduntil extubation were significantly shorter in the sevofluranegroup than in the propofol group: 3.7 (SD, 1.2)minutes vs 5 (3.1) minutes, respectively, for eye openingand 6.6 (1.2) minutes vs 8.1 (3.3) minutes for extubation(P<0.01). The incidence of nausea and vomiting was significantlyhigher in the sevoflurane group (40% vs 13%,respectively, P<0.01).CONCLUSIONS: Combining remifentanil with propofolor with sevoflurane provides satisfactory anesthesiaduring elective supratentorial craniotomy to remove abrain neoplasm. Hemodynamic stability is appropriateand recovery from anesthesia is rapid