Skip to main content
main-content

29.10.2019 | Original Article

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

Zeitschrift:
European Journal of Trauma and Emergency Surgery
Autoren:
Jayakumar Preethi, Prasanna Udupi Bidkar, Anusha Cherian, Ankita Dey, Swaminathan Srinivasan, Sethuramachandran Adinarayanan, Andy Sadanand Ramesh
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00068-019-01249-4) contains supplementary material, which is available to authorized users.

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).

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

★ PREMIUM-INHALT
e.Med Interdisziplinär

Mit e.Med Interdisziplinär erhalten Sie Zugang zu allen CME-Fortbildungen und Fachzeitschriften auf SpringerMedizin.de. Zusätzlich können Sie eine Zeitschrift Ihrer Wahl in gedruckter Form beziehen – ohne Aufpreis.

Weitere Produktempfehlungen anzeigen
Zusatzmaterial
Supplementary file1 (DOCX 552 kb)
68_2019_1249_MOESM1_ESM.docx
Literatur
Über diesen Artikel
  1. Sie können e.Med Orthopädie & Unfallchirurgie 14 Tage kostenlos testen (keine Print-Zeitschrift enthalten). Der Test läuft automatisch und formlos aus. Es kann nur einmal getestet werden.

Neu im Fachgebiet Orthopädie und Unfallchirurgie

21.11.2019 | ACR 2019 | Kongressbericht | Onlineartikel

Anifrolumab bei SLE nun doch mit signifikanten Ergebnissen

21.11.2019 | ACR 2019 | Kongressbericht | Onlineartikel

Handarthrose: Tops und Flops vom ACR-Kongress

21.11.2019 | ACR 2019 | Kongressbericht | Onlineartikel

JAK - selektive Inhibitoren bei RA mit Vorteilen?

21.11.2019 | ACR 2019 | Kongressbericht | Onlineartikel

Erste Daten zur Differentialtherapie der PsA

Mail Icon II Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Orthopädie und Unfallchirurgie und bleiben Sie gut informiert – ganz bequem per eMail.

Bildnachweise