A comparison of 1 minimum alveolar concentration desflurane and 1 minimum alveolar concentration isoflurane anesthesia in patients undergoing craniotomy for supratentorial lesions

Abstract

Background: A critical point in craniotomy is during opening of the dura and the subsequent potential for cerebral edema. Use of desflurane in neurosurgery may be beneficial because it facilitates early postoperative neurologic evaluation; however, data on the effect of desflurane on intracranial pressure in humans are limited. Isoflurane has been used extensively in neurosurgical patients.

Objective: This study compared 1 minimum alveolar concentration (MAC) desflurane with 1 MAC isoflurane in facilitating hemodynamic stability, brain relaxation, and postoperative recovery characteristics in patients who underwent craniotomy for supratentorial lesions.

Methods: A total of 70 patients (aged 18-65 years), with American Society of Anesthesiologists (ASA) 1 or 2 physical status, who underwent craniotomy for supratentorial lesions, were enrolled in the study. For induction of anesthesia, fentanyl (2 μg/kg IV) and propofol (2 mg/kg IV) were administered. Endotracheal intubation was performed after administration of vecuronium (0.1 mg/kg IV) for total muscle relaxation. Before insertion of the skull pins, additional fentanyl (2 μg/kg IV) was administered. Patients were randomly allocated to 1 of 2 anesthetic regimens. For maintenance of anesthesia, 35 patients received 1 MAC of desflurane (group 1) and 35 patients received 1 MAC of isoflurane (group 2) within 50% oxygen in nitrous oxide. Intraoperatively, heart rate (HR) and mean arterial pressure (MAP) were measured and recorded before induction and 1 minute after induction, after endotracheal intubation, before skull pin insertion and 1 minute after skull pin insertion, before incision and 1 minute after incision, and before extubation and 1 minute after extubation. Also, HR and MAP were recorded at 30-minute intervals. Postoperatively, extubation time, eye opening time to verbal stimuli, orientation time, and time to reach an Aldrete postanesthetic recovery score of ≥8 were recorded. In addition, opioid consumption was calculated and recorded. Brain relaxation was evaluated according to a 4-step brain relaxation scoring scale. All outcomes of the study were assessed and recorded by an anesthesiologist blinded to the volatile anesthetic gases studied.

Results: No significant difference in HR was observed between the 2 groups. Intraoperative MAP values in group 1 were higher than in group 2 (P < 0.05). No significant difference was found between these groups in brain relaxation and opioid consumption. Extubation time, eye opening time to verbal stimuli, and time to reach an Aldrete score of ≥8 were found to be significantly shorter in patients in group 1 compared with patients in group 2 (P < 0.05).

Conclusions: In patients who underwent craniotomy for supratentorial lesions, patients who received 1 MAC desflurane-based anesthesia had earlier postoperative cognitive recovery and postoperative neurologic examination compared with patients who received 1 MAC isoflurane-based anesthesia. The observed benefits of early recovery from anesthesia, however, should be considered with risks such as higher MAP in patients administered 1 MAC desflurane.

Keywords: desflurane; hemodynamic stability; isoflurane; neuroanesthesia; postoperative recovery.

Figure 1

Mean arterial pressure (MAP) values for the groups. Time intervals: before induction (1), 1 minute after induction (2), after endotracheal intubation (3), before skull pin insertion (4), 1 minute after skull pin insertion (5), before incision (6), 1 minute after incision (7), 30 minutes (8), 60 minutes (9), 90 minutes (10), 120 minutes (11), 150 minutes (12), 180 minutes (13), 210 minutes (14), 240 minutes (15), before extubation (16), 1 minute after extubation (17). *P < 0.05, compared with group 1 (Group DES). DES = desflurane; ISO = isoflurane.

Figure 2

Heart rate values for the groups. Time intervals: before induction (1), 1 minute after induction (2), after endotracheal intubation (3), before skull pin insertion (4), 1 minute after skull pin insertion (5), before incision (6), 1 minute after incision (7), 30 minutes (8), 60 minutes (9), 90 minutes (10), 120 minutes (11), 150 minutes (12), 180 minutes (13), 210 minutes (14), 240 minutes (15), before extubation (16), 1 minute after extubation (17). DES = desflurane; ISO = isoflurane.