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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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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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).

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Author information

Authors and Affiliations

  1. Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India

    Jayakumar Preethi, Anusha Cherian, Ankita Dey, Swaminathan Srinivasan & Sethuramachandran Adinarayanan

  2. In Charge Neuroanaesthesiology Division, Department of Anaesthesiology and Critical Care, JIPMER, Pondicherry, India

    Prasanna Udupi Bidkar

  3. Department of Neurosurgery, JIPMER, Pondicherry, India

    Andy Sadanand Ramesh

Authors
  1. Jayakumar Preethi
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  2. Prasanna Udupi Bidkar
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  3. Anusha Cherian
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  4. Ankita Dey
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  5. Swaminathan Srinivasan
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  6. Sethuramachandran Adinarayanan
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  7. Andy Sadanand Ramesh
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Contributions

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

Corresponding author

Correspondence to Prasanna Udupi Bidkar.

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Ethical approval

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

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Preethi, J., Bidkar, P.U., Cherian, A. et al. 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. Eur J Trauma Emerg Surg 47, 831–837 (2021). https://doi.org/10.1007/s00068-019-01249-4

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  • DOI: https://doi.org/10.1007/s00068-019-01249-4

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