Journal of Anesthesia

, Volume 32, Issue 2, pp 250–258 | Cite as

Comparison of propofol and desflurane for postanaesthetic morbidity in patients undergoing surgery for aneurysmal SAH: a randomized clinical trial

  • Avanish Bhardwaj
  • Hemant Bhagat
  • Vinod Kumar Grover
  • Nidhi Bidyut Panda
  • Kiran Jangra
  • Seelora Sahu
  • Navneet Singla
Original Article



Surgery for aneurysmal clipping after subarachnoid haemorrhage (SAH) poses a unique anaesthetic challenge. However, data on the influence of anaesthetic agents in these patients are lacking. The study aims to evaluate the superiority of propofol over desflurane for postanaesthetic morbidity in patients undergoing surgery following aneurysmal SAH.


Seventy World Federation of Neurosurgeons Grade I and II patients were randomized into propofol (n = 35) and desflurane groups (n = 35). Anaesthesia was maintained with propofol/fentanyl in propofol group and desflurane/fentanyl in the desflurane group. Jugular venous oxygen saturation (SjVO2) and brain relaxation were assessed intraoperatively. Time to eye opening, response to verbal commands, and extubation were noted from the time of discontinuing the anaesthetic agent. Duration of postoperative hospital stay and modified Rankin score (MRS) at discharge were subsequently compared.


Median postoperative hospital stay was 9 (6, 14) days with use of propofol and 9 (7, 12) days in desflurane group (P = 0.671). 18 patients in the propofol group and 14 patients in the desflurane group had good outcome (modified Rankin score 0–1; P = 0.453). Both the anaesthetics were similar in terms of intraoperative haemodynamics, brain relaxation, time to eye opening, response to verbal commands, and extubation time (P > 0.05). Emergence hypertension was more in the desflurane group (P = 0.007). The intraoperative SjVO2 values were significantly higher in the desflurane group (P < 0.05).


Propofol and desflurane are comparable in terms of postoperative morbidity in patients undergoing aneurysm neck clipping following SAH.


Propofol Desflurane Aneurysm Subarachnoid haemorrhage 


  1. 1.
    Linn FH, Rinkel GJ, Algra A, van Gijn J. Incidence of subarachnoid haemorrhage: role of region, year and rate of CT: a meta analysis. Stroke. 1996;27:625–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Van Gijn J, Rinkel GJ. Subarachnoid hemorrhage: diagnosis, causes and management. Brain. 2001;124:249–78.CrossRefPubMedGoogle Scholar
  3. 3.
    Haley EC Jr, Kassell NF, Torner JC. The International Cooperative Study on the timing of aneurysm surgery: the North American experience. Stroke. 1992;23:205–14.CrossRefPubMedGoogle Scholar
  4. 4.
    Wartenberg KE, Schmidt JM, Classeen J, Temes RE, Frontera JA, Ostapkovich N, Parra A, Connolly ES, Mayer SA. Impact of medical complications on outcome after subarachnoid haemorrhage. Crit Care Med. 2006;34:617.CrossRefPubMedGoogle Scholar
  5. 5.
    Kay B, Rolly G. I.C.I. 35868. The effect of a change of formulation on the incidence of pain after intravenous injection. Acta Anaesthesiol Belg. 1977;28:317–22.PubMedGoogle Scholar
  6. 6.
    Strebel S, Kaufman M, Guardiola PM, Schaefer HG. Cerebral vasomotor responsiveness is preserved during propofol and midazolam anaesthesia in humans. Anaesth Analg. 1994;78:884–8.CrossRefGoogle Scholar
  7. 7.
    Adembri C, Venturi L, Pellegrini Giampietro DE. Neuroprotective effects of propofol in acute cerebral injury. CNS Drug Rev. 2007;13:333–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Mielck F, Stephen H, Buhre W, Weyland A, Sonntag H. Effects of 1 MAC desflurane on cerebral metabolism, cerebral blood flow and carbon dioxide reactivity in humans. BJA. 1998;81:155–60.CrossRefPubMedGoogle Scholar
  9. 9.
    Engelhard K, Werner C, Reeker W, Lu H, Mollenberg O. Desflurane and isoflurane improve neurological outcome after incomplete cerebral ischaemia in rats. BJA. 1999;83:415–21.CrossRefPubMedGoogle Scholar
  10. 10.
    Matta BF, Mayberg TS, Lam AM. Direct cerebrovasodilatory effects of halothane, isoflurane and desflurane during propofol induced isoelectric electroencephalogram in humans. Anaesthesiology. 1995;83:980–5.CrossRefGoogle Scholar
  11. 11.
    Cheng MA, Ratnaraj J, McHugh TA, Dacey RG Jr, Tempelhoff R. Burst suppression during surgery for cerebral aneurysm: propofol vs. desflurane. Anesthesiology. 2002;96:A25.CrossRefGoogle Scholar
  12. 12.
    Foroohar M, Macdonald RL, Roth S, Stoodley M, Weir B. Intraoperative variables and early outcome after aneurysm surgery. Surg Neurol. 2000;54:304–15.CrossRefPubMedGoogle Scholar
  13. 13.
    Todd MM, Warner DS, Sokol MD, Mazen AM, Bradley JH, Franklin LS, Jerry K. A prospective comparative trial of three anaesthetics for elective supratentorial craniotomy: propofol/fentanyl, isoflurane/nitrous oxide, fentanyl/nitrous oxide. Anaesthesiology. 1993;78:1005–20.CrossRefGoogle Scholar
  14. 14.
    Peterson KD, Landsfeldt U, Cold GE, Petersen CB, Mau S, Hauerberg J, Holst P, Olsen KS. Intracranial pressure and cerebral haemodynamics in patients with cerebral tumors: a randomized prospective study of patients subjected to craniotomy in propofol-fentanyl, isoflurane-fentanyl or sevoflurane-fentanyl anaesthesia. Anaesthesiology. 2003;98:329–36.CrossRefGoogle Scholar
  15. 15.
    Bastola P, Bhagat H, Wig J. Comparative trial of propofol, sevoflurane and desflurane as a choice of anaesthesia in patients undergoing elective supratentorial craniotomy. Indian J Anaesth. 2015;59:287–94.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Fiset P, Paus T, Daloze T, Plourde G, Meuret P, Bonhomme V, Hajj-Ali N, Backman SB, Evans AC. Brain mechanism of propofol induced loss of consciousness in humans. A PET study. J Neurosci. 1999;19:5506–13.CrossRefPubMedGoogle Scholar
  17. 17.
    Schuttler J, Stoeckel H, Schwilden H. Pharmacokinetic and pharmacodynamics modelling of propofol (Diprivan) in volunteers and surgical patients. Postgrad Med J. 1985;61:53.CrossRefPubMedGoogle Scholar
  18. 18.
    Mishra LD. Cerebral blood flow and anaesthesia: a review. Indian J Anaesth. 2002;46:87–95.Google Scholar
  19. 19.
    Bhagat H, Dash Hari H, Bithal PK, Chouhan RS, Pandia MP. Planning for early emergence in neurosurgical patients: a randomized prospective trial of low dose anaesthetics. Anaesth Analg. 2008;107:1348–55.CrossRefGoogle Scholar
  20. 20.
    Basali A, Mascha EJ, Kalfas I, Schubert A. Relation between perioperative hypertension and intracranial haemorrhage after craniotomy. Anesthesiology. 2000;93:48–54.CrossRefPubMedGoogle Scholar
  21. 21.
    Gal TJ, Cooperman LH. Hypertension in the immediate postoperative period. BJA. 1975;47:70–4.CrossRefPubMedGoogle Scholar
  22. 22.
    Magni G, Baisi F, La Rosa I. No difference in emergence time and early cognitive function between sevoflurane-fentanyl and propofol-remifentanil in patients undergoing craniotomy for supratentorial intracranial surgery. J Neurosurg Anesthesiol. 2005;17:134–8.CrossRefPubMedGoogle Scholar
  23. 23.
    De Deyne C, Van Aken J, Decruyenaere J, Struys M, Colardyn F. Jugular bulb oximetry: review on a cerebral monitoring technique. Acta Anaesthesiol Belg. 1998;49:21–31.PubMedGoogle Scholar
  24. 24.
    Alkire MT, Haier RJ, Barker SJ, Shah NK, Wu JC, Kao YJ. Cerebral metabolism during propofol anesthesia in humans studied with positron emission tomography. Anesthesiology. 1995;82:393–403.CrossRefPubMedGoogle Scholar
  25. 25.
    Jansen GF, van Pragh BH, Kedaria MB, Odoom JA. Jugular bulb saturation during propofol and isoflurane/nitrous oxide anaesthesia in patients undergoing brain tumor surgery. Anaesth Analg. 1999;89:358–63.Google Scholar
  26. 26.
    Liao Ren, Li Jingyi, Liu Jin. Volatile induction/maintenance of anaesthesia with sevoflurane increases jugular venous oxygen saturation and lumbar cerebrospinal fluid pressure in patients undergoing craniotomy. Eur J Anaesthesiol. 2010;27:369–76.CrossRefPubMedGoogle Scholar
  27. 27.
    Villa F, Iacca C, Molinari AF, Gussani C, Aletti C, Pesenti A, Citerio GL. Inhalation versus endovenous sedation in subarachnoid haemorrhage patients. Effects on regional cerebral blood flow. Crit Care Med. 2012;40:2797–804.CrossRefPubMedGoogle Scholar
  28. 28.
    Kaisti KK, Langsjo JW, Aalto S, Oikonen V, Sipila H, Teras M, Hinkka S, Metsahonkala L, Scheinin H. Effects of sevoflurane, propofol and adjunct nitrous oxide on regional CBF, oxygen consumption and blood volume in humans. Anaesthesiology. 2003;99:603–13.CrossRefGoogle Scholar
  29. 29.
    Greif R, Akça O, Horn EP, Kurz A, Sessler DI, Outcomes Research Group. Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. N Engl J Med. 2000;342:161–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Belda FJ, Aguilera L, García de la Asunción J, Alberti J, Spanish Reduccion de la Tasa de Infeccion Quirurgica Group. Supplemental perioperative oxygen and the risk of surgical wound infection: a randomized controlled trial. JAMA. 2005;294:2035–42.CrossRefPubMedGoogle Scholar
  31. 31.
    Greif R, Laciny S, Rapf B, Hickle RS, Sessler DI. Supplemental oxygen reduces the incidence of postoperative nausea and vomiting. Anesthesiology. 1999;91:1246–52.CrossRefPubMedGoogle Scholar
  32. 32.
    Akca O, Podolsky A, Eisenhuber E, Panzer O, Hetz H, Lampl K, Lackner FX, Wittmann K, Grabenwoeger F, Kurz A, Schultz AM, Negishi C, Sessler DI. Comparable postoperative pulmonary atelectasis in patients given 30% or 80% oxygen during and 2 hours after colon resection. Anesthesiology. 1999;91:991–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Carpagnano GE, Kharitonov SA, Foschino-Barbaro MP, Resta O, Gramiccioni E, Barnes PJ. Supplementary oxygen in healthy subjects and those with COPD increases oxidative stress and airway inflammation. Thorax. 2004;59:1016–9.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Meyhoff CS, Wetterslev J, Jorgensen LN, Henneberg SW, Hogdall C, PROXI Trial Group. Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery. The PROXI randomized clinical trial. JAMA. 2009;302:1543–50.CrossRefPubMedGoogle Scholar
  35. 35.
    Van de Water J, Kagey KS, Miller IT, Parker DA, O’Connor NE, Sheh J-M, MacArthur JD, Zollinger RM Jr, Moore FD. Response of the lung to six to twelve hours of 100% oxygen inhalation in normal men. N Engl J Med. 1970;283:621–6.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2018

Authors and Affiliations

  • Avanish Bhardwaj
    • 1
  • Hemant Bhagat
    • 2
  • Vinod Kumar Grover
    • 2
  • Nidhi Bidyut Panda
    • 2
  • Kiran Jangra
    • 2
  • Seelora Sahu
    • 3
  • Navneet Singla
    • 4
  1. 1.Department of Anaesthesiology and Critical CareCommand Hospital (Airforce)BangaloreIndia
  2. 2.Division of Neuroanaesthesia, Department of Anaesthesia and Intensive CarePost Graduate Institute of Medical Education and ResearchChandigarhIndia
  3. 3.Department of Anaesthesiology and Critical CareTata Main HospitalJamshedpurIndia
  4. 4.Department of NeurosurgeryPost Graduate Institute of Medical Education and ResearchChandigarhIndia

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