Anesthesia For Neurosurgery Research Articles

Evaluation of effects of intravenous infusion of dexmedetomidine or lignocaine on stress response and postoperative pain in patients undergoing craniotomy for intracranial tumors: A randomized controlled exploratory study.

Goals of anesthesia in neurosurgery include stable cerebral hemodynamics and provide relaxed brain to surgeon. Dexmedetomidine and lignocaine as an adjuvant can fulfill these criteria but literature comparing the two are sparse. We compared the effects of intravenous infusion of dexmedetomidine or lignocaine on stress response, postoperative pain, and recovery in patients undergoing craniotomy for intracranial tumors. Approval was obtained from IEC, and the study was prospectively registered (CTRI/2022/11/047434). Written and informed consent was obtained from 105 patients fulfilling inclusion criteria, and they were divided into three groups. Group D received intravenous infusion of dexmedetomidine 1 mcg/kg over 15 minutes followed by infusion at rate of 0.5 mcg/kg/h, Group L received intravenous infusion of lignocaine 2 mg/kg over 15 minutes followed by infusion at rate of 1.5 mg/kg/h, and Group N received intravenous infusion of normal saline at the rate of 4-8 ml/h till skin suturing. SPSS v23 (IBM Corp.) was used for data analysis. There was a significant difference between groups in terms of intraoperative hemodynamic variations, brain relaxation score, extubation criteria, postoperative pain, stress indicator response, and quality of recovery. Dexmedetomidine as an adjuvant to anesthetic drugs has a better profile than lignocaine in suppressing stress response and preventing hemodynamic variations at intubation, skull pin application, and surgical incision. Dexmedetomidine increases the duration of effective analgesia more than lignocaine, in postoperative period in patients undergoing craniotomy.

Propofol-based Anesthesia versus Volatile Anesthesia on Brain Relaxation in Neurosurgery: A Meta-analysis of Randomized Controlled Trials

Background: The main objectives of neuroanesthesia are maintaining the stability of cerebral blood flow, intracranial pressure (ICP), and hemodynamics. Both intravenous and volatile anesthetics are frequently used in neuroanesthesia, yet the superior agent is still an ongoing debate. This study aimed to compare propofol-based versus volatile anesthesia on brain relaxation in patients undergoing neurosurgery. Subjects and Methods: PubMed, Cochrane, EMBASE, and ProQuest were searched using suitable keywords. Randomized controlled trials comparing propofol-based and volatile anesthesia for neurosurgery were included. The primary outcome was the brain relaxation score. Secondary outcomes were cerebral hemodynamics, intraoperative hemodynamics, recovery profiles, and postoperative complications. A meta-analysis was done to analyze the outcomes. Results: Seventeen studies (2135 patients) were included. Propofol-based group had lower ICP values (mean difference [MD]: −5.13 mmHg; 95% confidence interval [CI]: −6.95 to − 3.32; P < 0.00001); however, brain relaxation was similar within both groups. Intraoperative hemodynamics parameters were similar, aside from higher hypertension incidence in the propofol-based group. Remifentanil usage was higher with propofol-based anesthesia (MD: 1.08 μg; 95% CI: 0.72–1.44; P < 0.00001). Recovery profiles and postoperative complications were similar, with the exception of lower postoperative nausea and vomiting (PONV) incidence with propofol-based anesthesia (odds ratio = 0.59; 95% CI: 0.43–0.79; P = 0.0005). Conclusions: Propofol-based and volatile anesthesia provides comparable adequate brain relaxation in patients undergoing neurosurgery, although ICP was lower with propofol-based anesthesia. Propofol-based anesthesia significantly promoted the incidence of hypertension and reduced PONV. Other adverse events with both regimens were comparable.

Propofol Infusion Versus Isoflurane/Nitroglycerine Combination for Controlled Hypotensive Anesthesia in Neurosurgery

Background: The use of hypotensive anesthesia is one of several techniques that have been used to lessen the intraoperative loss of blood and improve visibility in the operative field. A procedure that requires a clear area and little intraoperative bleeding, which can affect the surgeons' abilities, is Neurosurgery. Objective: The current study aimed to assess how both anesthetics affected tissue perfusion, blood loss, operating field visibility, and extubation time. Settings and Design: A prospective quasi-experiment was used in the design of this clinical trial Practical Implication: The practical implication for choosing between propofol infusion and the isoflurane/nitroglycerine combination for controlled hypotensive anesthesia in neurosurgery includes considering several factors. Firstly, the patient's individual characteristics and medical history should be taken into account to determine the most suitable anesthesia approach. Secondly, the surgical procedure and the desired level of hypotension required should be evaluated. Thirdly, the availability and expertise of the anesthesia team in managing either method should be considered. Finally, potential side effects and complications associated with each technique should be weighed. Ultimately, a well-informed decision must be made based on these considerations to ensure the safety and efficacy of controlled hypotensive anesthesia in neurosurgery. Patients and Methods: Sixty individuals with ASA I or II were separated into two groups; Group P received both induction and maintenance doses of propofol, while Group I received isoflurane for maintenance with nitroglycerine. Blood loss, heart rate, mean arterial pressure, and the degree of surgical field clarity were all monitored every ten minutes. Results: As opposed to the isoflurane group, the propofol group substantial reduction in blood loss (p=0.01), improved clarity of the surgical field (p=0.002), and reduced time to extubation (p=0.001). Conclusion: Even with the addition of the hypertension medication nitroglycerine to isoflurane, propofol for craniotomy improved surgical conditions and gave a quicker recovery than isoflurane. Keywords: Nitroglycerin, Isoflurane, Propofol, Hypotensive Anesthesia, and Neurosurgery

Neurosurgical Anesthesia: Optimizing Outcomes with Agent Selection.

Anesthesia in neurosurgery embodies a vital element in the development of neurosurgical intervention. This undisputed interest has offered surgeons and anesthesiologists an array of anesthetic selections to utilize, though with this allowance comes the equally essential requirement of implementing a maximally appropriate agent. To date, there remains a lack of consensus and official guidance on optimizing anesthetic choice based on operating priorities including hemodynamic parameters (e.g., CPP, ICP, MAP) in addition to the route of procedure and pathology. In this review, the authors detail the development of neuroanesthesia, summarize the advantages and drawbacks of various anesthetic classes and agents, while lastly cohesively organizing the current literature of randomized trials on neuroanesthesia across various procedures.

Editorial introductions.

Current Opinion in Anesthesiology was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The fields of anesthesiology is divided into 16 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Anthony AbsalomAnthony AbsalomProf. Anthony Absalom studied medicine at the University of Cape Town, South Africa, and underwent specialist training in East Anglia and Scotland in the UK. He is currently Professor of Anaesthesiology at the University Medical Center Groningen, Netherlands. His clinical interests are procedural sedation, anaesthesia for neurosurgery, and intravenous anaesthesia techniques. His research interests are mostly in the domains of pharmacology and neuroscience. He is an editor of the British Journal of Anaesthesia, past President of the Society for Intravenous Anaesthesia, and a former vice-president of the World Society for Intravenous Anaesthesia. He is currently Chairman of the Neuroanaesthesia Section of the Dutch Association of Anaesthetists and past-Chair of the General Anaesthesia Scientific Sub-committee of the European Society of Anesthesiology. Ellen SoffinEllen SoffinEllen M. Soffin, MD, PhD is an Associate Professor of Anesthesiology, Weill Cornell Medical College, New York, USA and an anesthesiologist at Hospital for Special Surgery, New York, USA. She is the Director of the Anesthesia-Spine Service, and Co-Director of the Hospital for Special Surgery's interdisciplinary spine research program. Dr Soffin earned her medical degree at King's College Medical School, London, UK and PhD in neuroscience at Edinburgh University, Edinburgh, UK, before moving to the United States. She completed residency training in anesthesiology at The Johns Hopkins Hospital, Baltimore, Maryland, USA and a fellowship in regional anesthesia and acute pain medicine at Hospital for Special Surgery. Dr Soffin's research interests include evaluating the role and value of field and fascial plane blocks for the spine surgery patient; optimizing surgical outcomes using enhanced recovery pathways for total joint arthroplasty and spine surgery; and implementation of regulatory, institutional, and clinical strategies for opioid stewardship programs. She has published extensively on outcomes related to pathway-based care, regional analgesia techniques, and opioid-minimizing approaches to the perioperative care of the orthopedic surgery patient. Dr Soffin serves on the editorial board of Regional Anesthesia & Pain Medicine and is the Section Editor, Acute Pain and Perioperative Care, for Journal of Pain Research. She is an active faculty member of American Society of Regional Anesthesia & Pain Medicine, the American Academy of Pain Medicine, and the Society of Anesthesia & Sleep Medicine, where she is the co-chair of the research committee.

Ultrasound-Guided Scalp Blocks for an Awake Craniotomy: A Case Report

Ultrasound-guided scalp blocks may revolutionize regional anesthesia for neurosurgery. In this report, we demonstrate that ultrasound-guided scalp blocks can be used effectively for a craniotomy. A 48-year-old patient with a brain tumor at the motor cortex was scheduled for an awake craniotomy. Ultrasound-guided scalp blocks targeting the bilateral supraorbital, supratrochlear, zygomaticotemporal, auriculotemporal, greater auricular, lesser occipital, greater occipital, and third occipital nerves were performed. A total of 29 mL of levobupivacaine 0.3% was used. No additional local anesthetic agent was given for skull pinning, skin incision, or the craniotomy. Postoperatively, the patient remained pain-free, and she was discharged without complications.

Effect of Magnesium Sulfate on the Total Anesthetic and Analgesic Requirements in Neurosurgery

Introduction: The intraoperative anesthetic and postoperative analgesic requirements are of great importance especially in neurosurgical anesthesia. This requires balancing a deep and effective anesthesia and postoperative analgesia versus the risks of delayed recovery and postoperative respiratory depression from excessive analgesics. Magnesium sulfate is an antagonist of the N-Methyl-D-Aspartate (NMDA) receptors in a voltage-dependent fashion. Propofol also inhibits the NMDA subtype of the glutamate receptor. Therefore, magnesium sulfate when coadministered with propofol potentiates anesthetic effect and NMDA antagonism of propofol. Majority of the studies that evaluated the anesthetic and analgesic requirement in patients receiving magnesium sulfate depended on the clinical parameters, for example, hemodynamic parameters and measurement of pain scores. In this study, we added bispectral index (BIS) and neuromuscular monitoring using train-of-four (TOF) to adjust intraoperative anesthetic requirements in addition to the clinical parameters.
 Methodology: This randomized controlled double-blind study included 50 adult ASA I and II male and female patients undergoing neurosurgical maneuvers. Patients were randomly divided into two equal groups. Routine intraoperative monitoring including invasive BP and in addition TOF and BIS were applied. In a blind fashion, patient in group I (Magnesium group) received magnesium sulfate 20 mg/kg as bolus dose over 5 min followed by 0.1 ml/kg/hr of 10% solution as infusion, while patient in group II (Control group) received saline with the same bolus and infusion rates after the induction of anesthesia. Anesthesia was induced in both groups by fentanyl 2 µg/kg, propofol 1.5–2 mg/kg, and rocuronium in a dose of 0.6 mg/kg to facilitate ETT insertion. This is followed by continuous infusion of propofol 6–10 mg/kg/hr and fentanyl 1–2 mic/kg/hr. The parameters which were assessed included hemodynamic parameters (HR and BP), TOF, and BIS. Total consumptions of propofol, fentanyl, rocuronium, and postoperative analgesic requirements (PCA morphine) were recorded. In addition, recovery time and postoperative pain score by visual analog scale (VAS) were recorded.
 Result: There was no significant difference in patient characteristics between the two groups. As regard the hemodynamic changes and BIS, no significant difference was seen between the two groups except the HR change which was significantly reduced (p = 0.005) with surgical stimulation in group I compared to the other group. Results also showed that the mean fentanyl, propofol, and rocuronium consumption, recovery time, degree of postoperative pain, and postoperative analgesic requirements were significantly less in patients that received magnesium sulfate infusion compared to those in the control group.
 Conclusion: Magnesium sulfate is most likely a safe and cost-effective supplement to the general anesthesia in neurosurgery as it reduces the total anesthetic and analgesic requirements and postoperative pain.

English

BACKGROUND Anaesthesia for neurosurgery requires special considerations. The brain is enclosed in a rigid cranium, so the rise in intracranial pressure (ICP) which impairs cerebral perfusion pressure (CPP), results in irrepairable damage to various vital areas in the brain. Stable head position is required in long neurosurgical procedures. This is obtained with the use of clamps which fix the head rigidly. This is done usually under general anaesthesia because it produces intense painful stimuli leading to stimulation of sympathetic nervous system which in turn causes release of vasoconstrictive agents. This can impair perfusion in all organ systems. The increase in blood pressure due to sympathetic nervous system causes increase in blood flow. This causes increases in intracranial pressure which result in reduction in cerebral perfusion pressure once the auto regulatory limits are exceeded. We compared the effects of dexmedetomidine 1 µgm/kg and propofol 100 µgm/kg given as infusion over a period of 10 minutes before the induction of anaesthesia and continued till 5 minutes after pinning to attenuate the stress response while cranial pinning. In this study, we wanted to compare the effects of dexmedetomidine and propofol as infusion to attenuate the stress response while cranial pinning in patients undergoing neurosurgical procedures. METHODS This is a randomized interventional trial. Patients were divided into 2 groups of 20 each. Group 1 receiving dexmedetomidine and group 2 receiving propofol, both drugs given as infusion. Haemodynamic variables were monitored before and after cranial pinning. Data was analysed using IBM statistical package for social sciences (SPSS) statistics. The parameters recorded were analysed with the help of a statistician. RESULTS The two groups were comparable in demographic data. Incidence of tachycardia between group 1 and 2 showed that tachycardia to pinning was better controlled with propofol than dexmedetomidine (P < 0.05) which is statistically significant. There is no statistically significant difference in blood pressure values between group 1 and 2 after pinning. CONCLUSIONS From our study, we came to a conclusion that propofol was superior to dexmedetomidine in attenuating the heart rate response to cranial pinning. The effect of propofol and dexmedetomidine was comparable in attenuating the blood pressure response to cranial pinning. KEYWORDS Cranial Pinning, Dexmedetomidine, Propofol

Esmolol as an adjunct to general balanced anaesthesia in neurosurgery

Background/Aim: In surgery, and especially in the neurosurgical operations, maintenance of cardiovascular stability during and in the phase of the immediate postoperative recovery is of vital importance. The aim of this study was to investigate the effects of continuous esmolol infusion on the values of cardiovascular parameters and quality of the emergence from anaesthesia in neurosurgical patients. Methods: A total of 40 patients of both sexes scheduled for elective supratentorial surgery were randomly assigned to two groups. Esmolol group received intravenous (iv) infusion of esmolol dissolved in 5 % glucose solution (during the first 5 min at a rate of 0.3 mg/kg/min and thereafter at a rate of 0.1 mg/kg/min), while the ones from the control group received a 5 % glucose solution without esmolol at the same volume and rate. Cardiovascular parameters were registered at critical phases of anaesthesia and operation (induction, intubation, placement of Mayfield frame, craniotomy, skull closure, extubation). Recovery after anaesthesia was assessed based on times of eye opening on command, spontaneous eye opening and regaining of full orientation. Results: Values of systolic blood pressure and heart rate were significantly lower in the esmolol than in the control group of patients. Although the durations of anaesthesia did not differ, patients from the esmolol group required significantly less opioids and isoflurane and recovered after the anaesthesia significantly faster than the patients in the control group. Conclusion: Ultrashort-acting beta-adrenergic receptor antagonist esmolol, administered as a continuous iv infusion, assures better cardiovascular stability and smoother emergence from the balanced inhalation general anaesthesia than the control glucose infusion in elective neurosurgical patients.

Application of Grid Complexity-Based Magnetic Resonance Imaging in Monitoring Electroencephalogram Signals of Anesthetized Patients

Objective: In this paper, a lattice algorithm is used to explore the effect of MRI on anesthesia when used in neurosurgery. Methods: Sixty patients with glioma were randomly divided into two groups. Thirty patients underwent intracranial glioma resection (iMRI group) under the guidance of intraoperative magnetic resonance imaging (iMRI) and functional neuronavigational, and 30 patients underwent functional neuronavigational. Guide the traditional resection of traditional craniotomy gliomas (group N), and record the general situation, anesthesia time, operation preparation time, operation time, intraoperative blood loss, infusion volume, blood transfusion rate, preoperative and postoperative hemoglobin concentrations, Postoperative body temperature, dosage of muscle relaxant, perioperative accidents related to iMRI and anesthesia. Results: Compared with the N group, the general conditions, anesthesia time, intraoperative blood loss, infusion volume, blood transfusion rate, hemoglobin concentration, and postoperative body temperature of the patients in the iMRI group were not significantly different (P > 0.05), but the time for preparation and operation. It was significantly prolonged, and the amount of muscle relaxant was significantly increased (P < 0.05). There were no accidents related to iMRI and anesthesia in both groups. Conclusion: The use of iMRI in neurosurgical surgery improves the accuracy of surgery and makes tumor resection more complete, but the operation time is significantly longer, and other perioperative characteristics are not different from traditional neurosurgery. iMRI is used for anesthesia in neurosurgery. In addition to following the general principles of neurosurgery anesthesia, attention should also be paid to the regulation of anesthesia for long-term surgery.

Anesthesia for neurosurgery (Part II)

The central nervous system (CNS) deserves special consideration in the perioperative setting for several reasons for an anesthetist. An understanding of neuroanatomy is essential because neuro anesthesia continues to develop and evolution of neurosurgical practice is accompanied by new challenges for the anesthetist. Basic knowledge and expertise of the neuro-anesthetist can directly influence patient outcome. With the recent advancement in functional and minimally invasive procedures, there is an increased emphasis on the provision of optimal operative conditions, preservation of neurocognitive function, minimizing interference with electrophysiological monitoring, and a rapid, high-quality recovery. So, during neuro anesthesia, anesthesiologist needs to know physiology of CNS including cerebral metabolism and cerebral blood flow. Neuro anesthesia can be challenging, because sometimes apparently contradictory demands must be managed, for example, achieving optimal conditions for neurophysiological monitoring while maintaining sufficient anesthetic depth, or maintaining oxygen delivery to neuronal tissue and simultaneously preventing high blood pressures that might induce local bleeding. One of the peculiarities of neuro anesthesia has always been that as much importance is attached to wakening the patient as sending them to sleep. We have included the anesthesia for neurosurgery in two parts. In the first part, we had discussed cerebral anatomy, physiology and intracranial pressure, in the second part we have included anesthesia considerations for surgery for brain tumor, aneurysmal surgery, temporal lobe surgery, trans sphenoidal surgery and traumatic brain injury. Keywords: Anesthesia, Neurosurgery.

Anesthesia for Neurosurgery (Part I)

The central nervous system (CNS) deserves special consideration in the perioperative setting for several reasons for an anesthetist. An understanding of neuroanatomy is essential because neuro anesthesia continues to develop and evolution of neurosurgical practice is accompanied by new challenges for the anesthetist. Basic knowledge and expertise of the neuro-anesthetist can directly influence patient outcome. With the recent advancement in functional and minimally invasive procedures, there is an increased emphasis on the provision of optimal operative conditions, preservation of neurocognitive function, minimizing interference with electrophysiological monitoring, and a rapid, high-quality recovery. So, during neuro anesthesia, anesthesiologist needs to know physiology of CNS including cerebral metabolism and cerebral blood flow. Neuro anesthesia can be challenging, because sometimes apparently contradictory demands must be managed, for example, achieving optimal conditions for neurophysiological monitoring while maintaining sufficient anesthetic depth, or maintaining oxygen delivery to neuronal tissue and simultaneously preventing high blood pressures that might induce local bleeding. One of the peculiarities of neuro anesthesia has always been that as much importance is attached to wakening the patient as sending them to sleep.

Inhaled anesthesia in neurosurgery: Still a role?

In patients undergoing craniotomy, general anesthesia should be addressed to warrant good hypnosis, immobility, and analgesia, to ensure systemic and cerebral physiological status and provide the best possible surgical field. Regarding craniotomies, it is unclear if there are substantial differences in providing general anesthesia using total intravenous anesthesia (TIVA) or balanced anesthesia (BA) accomplished using the third generation halogenates. New evidence highlighted that the last generation of halogenated agents has possible advantages compared with intravenous drugs: rapid induction, minimal absorption and metabolization, reproducible pharmacokinetic, faster recovery, cardioprotective effect, and opioid spare analgesia. This review aims to report evidence related to the use of the latest halogenated agents in patients undergoing craniotomy and to present available clinical evidence on their effects: cerebral and systemic hemodynamic, neurophysiological monitoring, and timing and quality of recovery after anesthesia.

The effects of intravenous dexmedetomidine on hemodynamic response in patients undergoing skull-pin head-holder application during neurosurgery – A meta-analysis of randomized controlled trials

ObjectivesSkull-pin head-holder application during neurosurgery is a highly noxious stimulus that may lead to abrupt hemodynamic change, which is an unfavorable response to maintain hemodynamics stability. The aim of this meta-analysis was to evaluate the effects of intravenous dexmedetomidine on hemodynamic response (blood pressure and heart rate) resulting from the application of skull-pin head-holder in neurosurgery. Patients and methodsA systematic review and meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. The protocol was registered with the International Prospective Register of Systematic Reviews (CRD 420119127876). Electronic databases were searched, without discrimination of publication year, language, and region, to identify all randomized controlled trials investigating the effects of dexmedetomidine on hemodynamic response resulting from skull-pin head-holder application during general anesthesia for neurosurgery. The mean arterial pressure and heart rate were analyzed using random-effect model, and the mean difference (MD) was calculated. ResultsSeventeen trials were identified; a total of 878 patients were enrolled. The analysis indicated that dexmedetomidine infusion reduced the mean arterial pressure (MD −11.70, 95% confidence interval [CI] −16.33 to −7.07, p < 0.00001) and heart rate (MD −14.48, 95% CI −23.10 to −5.86, p = 0.001) during skull-pin head-holder application. Subgroup analysis showed that dexmedetomidine was superior to fentanyl for the attenuation of hemodynamic response. Dexmedetomidine infusion also reduced the incidence of hypertension, tachycardia and brain relaxation score. ConclusionThe result of this analysis indicates that intraoperative dexmedetomidine administration could decrease the hemodynamic response and provide hemodynamic stability during skull-pin head-holder application in neurosurgery.

REGIONAL ANESTHESIA FOR NEUROSURGERY.

SummaryDuring neurosurgery procedures it is vital to assure optimal cerebral perfusion and oxygenation. Despite physiological autoregulation of brain perfusion, maintaining hemodynamic stability and good oxygenation during anesthesia is vital for success. General anesthesia with mechanical ventilation and current drugs provide excellent hemodynamic condition and it is the first choice for most neurosurgery procedures. However, sometimes it is very hard to avoid brief increase or decrease in blood pressure especially during period of intense pain, or without pain stimulation. This could be detrimental for patients presented with high intracranial pressure and brain edema. Modifying anesthesia depth or treatment with vasoactive drugs usually is needed to overcome such circumstances. On the other hand it is important to wake the patients quickly after anesthesia for neurological exam. That is why regional anesthesia of scalp and spine could show beneficial effects by decreasing pain stimuli and hemodynamic variability with sparing effect of anesthetics drugs. Also regional techniques provide excellent postoperative pain relief, especially after spinal surgery

Comparison of hemodynamic response between propofol and thiopental as an induction agent in neurosurgery anesthesia at Haji Adam Malik General Hospital Medan-Indonesa

Comparison of hemodynamic response between propofol and thiopental as an induction agent in neurosurgery anesthesia at Haji Adam Malik General Hospital Medan-Indonesa

Total Intravenous Anesthesia in Neurosurgery

AbstractIn recent years, neurosurgical anesthesia has been rapidly evolving in the fields of pharmacotherapy and techniques to administer safe anesthesia. Intravenous (IV) anesthetic agents reduce both cerebral blood flow and intracranial pressure besides maintaining flow–metabolism coupling in contrast to inhalational agents. In neuroanesthesia, the technique and choice of drugs directly influence the outcome of the patients. The purpose of this review is to provide the updated information of total intravenous anesthesia (TIVA) in neuroanesthesia. Administration of TIVA using target-controlled infusion technique is emerging as a standard method to administer safe anesthesia in neurosurgical patients. The propofol–remifentanil combination has become very popular due to their favorable pharmacokinetic and pharmacodynamic properties for neurosurgery cases. Plasma-effect site concentration monitoring from target TCI devices together with electroencephalogram or bispectral index monitors allows easy titration of anesthetic agents to ensure adequate depth of anesthesia depending upon the nociceptive stimulus. TIVA is associated with smooth induction and rapid emergence with less postoperative nausea and vomiting.

Comparison of the Effects of Total Intravenous Anesthesia and Intravenous Inhalational Anesthesia on Brain Metabolism during Surgery

To compare the effects on the brain metabolism of propofol-remifentanil total intravenous anesthesia and desflurane-remifentanil intravenous inhalational anesthesia in neurosurgery. Methods: Thirty-four neurosurgical patients with intracranial space-occupying surgery were randomly divided into two groups: Group A was conducted with the propofol-remifentanil total intravenous anesthesia and Group B with desflurane-remifentanil intravenous inhalational anesthesia. The patients were monitored for the brain metabolism prior to anesthesia, 1 hour after surgery, 2 hours after surgery, and half an hour after surgery. Results: The cerebral venous oxygen saturation, jugular bulb oxygen partial pressure, jugular vein oxygen content, and arterial oxygen content of the patients in group B were significantly higher than that of group A (P<0.001); arterial-jugular oxygen content difference and brain oxygen uptake rate of group B were lower than that in group A. Conclusions: (1) Both anesthesia methods can reduce the cerebral oxygen consumption and brain oxygen uptake, and thus reduce the cerebral oxygen metabolism.

Desflurane in neurosurgery: Pros

Neurosurgery and neuroanaesthesia are making rapid progress, and with this progress, there is the search for excellence and ideal results. The practice of neuroanaesthesia is fairly standardised today, and any debate can only be on the fine-tuning aspects of the techniques. The aim of all research in anaesthesia is to provide the best possible and safest operating conditions and to have a complete recovery at the end of the surgery. The maintenance of anaesthesia for neurosurgery is with balanced general anaesthesia which combines intravenous and inhalational agents. A review of literature shows that desflurane has definite advantages, and hence, it is an integral part of modern neuroanaesthesia.

神经外科手术中的电生理监测与麻醉

神经外科手术中的电生理监测与麻醉