Abstract
The choice of anaesthetic techniques is important for the outcome of traumatic brain injury (TBI) emergency surgery. The objective of this study was to compare patient outcomes for target-controlled infusion (TCI) of propofol and sevoflurane anaesthesia. A total of 110 severe TBI patients, aged 18-60, who underwent emergency brain surgery were randomised into Group T (TCI) (n = 55) and Group S (sevoflurane) (n = 55). Anaesthesia was maintained in Group T with propofol target plasma concentration of 3-6 μg/mL and in Group S with minimum alveolar concentration (MAC) of sevoflurane 1.0-1.5. Both groups received TCI remifentanil 2-8 ng/mL for analgesia. After the surgery, patients were managed in the intensive care unit and were followed up until discharge for the outcome parameters. Demographic characteristics were comparable in both groups. Differences in Glasgow Outcome Scale (GOS) score at discharge were not significant between Group T and Group S (P = 0.25): the percentages of mortality (GOS 1) [27.3% versus 16.4%], vegetative and severe disability (GOS 2-3) [29.1% versus 41.8%] and good outcome (GOS 4-5) [43.6% versus 41.8%] were comparable in both groups. There were no significant differences in other outcome parameters. TCI propofol and sevoflurane anaesthesia were comparable in the outcomes of TBI patients after emergency surgery.
Highlights
Traumatic brain injury (TBI) is one of the main causes of morbidity and mortality worldwide
The objective of the present study was to compare the outcome of traumatic brain injury (TBI) patients after emergency surgery under total intravenous anaesthesia (TIVA)/target-controlled infusion (TCI) of propofol and sevoflurane anaesthesia techniques in terms of percentage of successful extubation, percentage of required tracheostomy, length of intensive care unit (ICU) and hospital stay, score on the Glasgow outcome scale (GOS) and mortality
A total of 110 patients undergoing emergency craniotomy/craniectomy for severe TBI were enrolled for the study after written informed consent was obtained from of kin
Summary
Traumatic brain injury (TBI) is one of the main causes of morbidity and mortality worldwide. Data from the United States show that an estimated 1.7 million cases of TBI occur every year that may cause severe disability and death [1]. Based on the first Malaysian National Trauma Database, 42.8% of 123,916 registered trauma patients had severe TBI with a Glasgow. Other local data showed that, out of 5,836 paediatric patients (aged 0–19) who were admitted to emergency departments for trauma, 742 (12.7%) suffered from brain injuries. The overall rate of childhood brain injury for that one-year period was 32 per 100,000 children, while the incidence of moderate to severe brain injury was approximately 8 per 100,000 children [3]. The choice of anaesthetic techniques is important for the outcome of traumatic brain injury (TBI) emergency surgery. The objective of this study was to compare patient outcomes for target-controlled infusion (TCI) of propofol and sevoflurane anaesthesia
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