Propofol vs isoflurane for neurosurgical anesthesia in Thai patients

Abstract

Sixty Thai patients, ASA class I-II, Glasgow coma score of 15 undergoing elective intracranial surgery were randomly assigned to 2 groups. In group I, 30 patients were induced with thiopental 3-5 mg/kg, intubation with succinylcholine 1-2 mg/kg and then maintained with 60 per cent N2O in O2, isoflurane and vecuronium as a muscle relaxant. In group II, 30 patients received fentanyl 50 micrograms, propofol 1.0-2.5 mg/kg for induction and vecuronium 0.08 mg/kg for intubation then maintained with 60 per cent N2O in O2, continuous infusion of propofol 2-12 mg/kg/h and vecuronium as a muscle relaxant. Controlled ventilation in both groups was set to maintain PET CO2 in the range of 28-35 mmHg. 3 patients (1 in group I and 2 in group II) were excluded from the study due to surgical problems. There was no statistical difference in age, sex, ASA status, weight, duration of anesthesia. Group II had a more stable systolic BP, Diastolic BP and Pulse rate than Group I during induction and emergence from anesthesia. Glasgow coma scores in the recovery period, Group II had higher scores than Group I at 5 and 15 minutes but not at 30 minutes. Mean recovery times (eye opening) was 14.03 +/- 4.85 minutes in group I which is significantly different from 10 +/- 5.17 minutes in group II. The cost of anesthesia in group II was 1.3 times that of group I. In conclusion, although neurosurgical anesthesia for Thai patients with fentanyl-propofol technique produces more stable blood pressure during intubation and emergence, rapid recovery from anesthesia and a higher Glasgow coma score, the cost of anesthesia is more expensive. Furthermore, this technique is more difficult and needs more experience.