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

  • Jayakumar Preethi
  • Prasanna Udupi BidkarEmail author
  • Anusha Cherian
  • Ankita Dey
  • Swaminathan Srinivasan
  • Sethuramachandran Adinarayanan
  • Andy Sadanand Ramesh
Original Article



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).


TIVA Inhalational agents Traumatic brain injury ICP 


Author contribution

All authors have equally contributed in the preparation of protocol, the conduct of study, and manuscript preparation.

Compliance with ethical standards

Conflict of interest


Ethical approval

Institute ethics committee IEC no. - JIP/IEC/2016/1103.

Supplementary material

68_2019_1249_MOESM1_ESM.docx (552 kb)
Supplementary file1 (DOCX 552 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Anaesthesiology and Critical CareJawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)PondicherryIndia
  2. 2.In Charge Neuroanaesthesiology Division, Department of Anaesthesiology and Critical CareJIPMERPondicherryIndia
  3. 3.Department of NeurosurgeryJIPMERPondicherryIndia

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