A prospective randomized single blind study of a comparison between total inravenous anaesthesia with propofol and conventional sevoflurane (inhalational) anaesthesia for their effect on the brain bulk during elective craniotomy for supratentorial tumor

 

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Introduction: Inhalational agents cause a dose dependant cerebral vasodilation and increase intracranial pressure (ICP). Total intravenous anaesthesia (TIVA) has no cerebral vasodilatory effect, A combination technique of inhalational and intravenous anaesthesia combines the advantage of both. We conducted a study to compare brain relaxation in three groups: TIVA, inhalational and IV+ (IV plus inhalational). Methods: Following institutional ethics committee approval, 80 patients (n = 80, calculated by ClinCalc Sample Size Calculator), posted for elective neurosurgery were included in this study. After intubation, in Group TIVA, anaesthesia was maintained with propofol infusion. Group INH, anaesthesia was maintained with sevoflurane. Group IV+, anaesthesia was maintained with combination of propofol and sevoflurane upto 1 MAC, titrated to keep bispectral index (BIS) 40-50. The brain relaxation/bulge and surgical field was graded according to a subjective four point scale. Results: The brain relaxation score was significantly better (p = 0.033) in Group TIVA. Grade I relaxation was higher in Group TIVA n = 25 (62.5%) than in Group IV+ n = 14 (35%). Group INH was discontinued because in the 8 cases conducted, there was unacceptable brain bulge requiring intervention. Conclusion: We concluded that TIVA provide a better surgical field in view of brain relaxation as compared to the combination of IV+ Inhalational and the conventional Inhalational anaesthesia. Though the measurement of brain relaxation in our study was subjective, monitoring of ICP during first burr hole in the skull would have been objective and ideal.