Comparison of intraoperative brain condition, hemodynamics and postoperative recovery between desflurane and sevoflurane in patients undergoing supratentorial craniotomy

Abstract

Background: 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.

Materials and methods: Fifty three patients between 18-60yr undergoing elective supratentorial craniotomy receiving N2O 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.

Results: 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.

Conclusion: In patients undergoing elective supratentorial craniotomy both sevoflurane and desflurane had similar intra-operative brain condition, hemodynamics and post operative recovery profile.

Keywords: Desflurane; intracranial pressure; recovery; sevoflurane; supratentorial craniotomy.

Figure 1

Consort flow diagram of the study

Figure 2

Figure showing heart rate and mean arterial pressure at baseline and at different intervals in the induction, intubation and maintenance phase. Bl: Base line; 1: Induction; 2: Intubation; 3-7: 5 min postintubation at 1 min interval; 8: Pin fixation; 9-31: After pin fixation at 15 min interval till tapering of inhalational agents

Figure 3

Figure showing heart rate and mean arterial pressure from tapering of inhalational agents till 10 min after extubation. Tap: Tapering of inhalational agents; T_1 to T_22: At 1 min interval from tapering of inhalational agents till extubation; Ext: At extubation; Ext1-Ext10: At 1 min interval from extubation till 10 min of extubation

Figure 4

Figure showing heart rate and mean arterial pressure in the postoperative period. PO: Baseline postoperative on Intensive care unit (ICU) admission; 15-180: From 15 min of ICU admission to 180 min of ICU admission

Figure 5

Short Orientation Memory Concentration Test score of the patients at different intervals. BL: Base line; PO: Baseline postoperative on Intensive care unit (ICU) admission; T15-T180: From 15 min of ICU admission to 180 min of ICU admission