Comparison of total intravenous anesthesia vs. inhalational anesthesia on brain relaxation, intracranial pressure, and hemodynamics in patients with acute subdural hematoma undergoing emergency craniotomy: a randomized control trial
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The major goals of anesthesia in patients with severe traumatic brain injury (TBI) are—maintenance of hemodynamic stability, optimal cerebral perfusion pressure, lowering of ICP, and providing a relaxed brain. Although both inhalational and intravenous anesthetics are commonly employed, there is no clear consensus on which technique is better for the anesthetic management of severe TBI.
Ninety patients, 18–60 years of age, of either gender, with GCS < 8, posted for emergency evacuation of acute subdural hematoma were enrolled in this prospective trial, and they were randomized into two groups of 45 each. Patients in group P received propofol infusion at 100–150 mg/kg/min for maintenance of anesthesia and those in group I received ≤ 1 MAC of isoflurane. Hemodynamic parameters were monitored in all patients. ICP was measured at the dural opening and brain relaxation was assessed by the operating surgeon on a four-point scale (1-perfectly relaxed, 2-satisfactorily relaxed, 3-firm brain, and 4-bulging brain) at the dural opening. It was reassessed at dural closure.
Brain relaxation, both at dural opening and closure, was significantly better in patients who received propofol compared to those who received isoflurane. ICP was significantly lower (25.47 ± 3.72 mmHg vs. 23.41 ± 3.97 mmHg) in the TIVA group. Hemodynamic parameters were well maintained in both groups.
In patients with severe TBI, total intravenous (Propofol)-based anesthesia provided better brain relaxation, maintained a lower ICP along with better hemodynamics when compared to inhalational anesthesia.
Clinical trial registration
Clinical trials registry (NCT03146104).
KeywordsTIVA Inhalational agents Traumatic brain injury ICP
All authors have equally contributed in the preparation of protocol, the conduct of study, and manuscript preparation.
Compliance with ethical standards
Conflict of interest
Institute ethics committee IEC no. - JIP/IEC/2016/1103.
- 4.Prabhakar H, Singh GP, Mahajan C, Kapoor I, Kalaivani M, Anand V. Intravenous versus inhalational techniques for rapide mergence from anaesthesia in patients undergoing brain tumour surgery. Cochrane Database Syst Rev 2016, Issue 9. Art.No.: CD010467.Google Scholar
- 8.Struys MMRF, Absalom AR, Shafer S. Intravenous drug delivery systems. In: Miller RD, ed. 8th ed. Miller’s Anesthesia. Philadelphia: Elsevier Inc.; 2015:920Google Scholar
- 9.Petersen KD, Landsfeldt U, Cold GE, et al. Intracranial pressure and cerebral hemodynamic in patients with cerebral tumors: a randomized prospective study of patients subjected to craniotomy in propofol-fentanyl, isoflurane-fentanyl, or sevoflurane-fentanyl anesthesia. Anesthesiology. 2003;98:329–36.CrossRefGoogle Scholar
- 13.Folino TB, Parks LJ. Propofol. [Updated 2018 Oct 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430884
- 20.Mishra LD, Dube SK, Singh SN, Dubey RK. Comparison between continuous propofol infusion and conventional balanced anaesthesia in neurosurgical patients. J Anaesth Clin Pharmacol. 2008;24:399–402.Google Scholar
- 24.Jorgensen HA, Bundgaard H, Cold GE. Subdural pres-sure measurement during posterior fossa surgery Correlation studies of brain swelling/herniation af-ter dural incision with measurement of subdural pres-sure and tactile estimation of dural tension. Br J Neurosurg. 1999;13:449–53.CrossRefGoogle Scholar