Three balanced anesthetic techniques for neuroanesthesia: infusion of thiopental sodium with sufentanil or fentanyl compared with inhalation of isoflurane.
OBJECTIVE
To compare emergence from anesthesia and the hemodynamic and respiratory depressant effects of thiopental sodium infusion plus sufentanil or fentanyl with those of isoflurane as the primary component of a balanced technique for neuroanesthesia.


METHODS
Randomized, double-blind, prospective study.


METHODS
University hospital and its affiliated Veterans Affairs Medical Center.


METHODS
Thirty patients undergoing elective craniotomy for aneurysm or tumor.


METHODS
Thiopental with infusion of sufentanil 0.1 microgram/kg/hr, thiopental with infusion of fentanyl 1 microgram/kg/hr, or inhalation of 0.25% to 2% isoflurane as the major component of a balanced anesthesia technique that included nitrous oxide (N2O) and vecuronium (potency ratio of sufentanil to fentanyl, 10:1).


RESULTS
Intraoperative stress response (as indicated by intraoperative hypertension) was said to be the percentage of time the patient required administration of an antihypertensive drug, measuring from the first dose of thiopental to discontinuation of N2O at the end of the procedure, excluding any period of induced hypotension. Rapidity of emergence was measured by the number of minutes from discontinuation of N2O to first opening of the eyes on command. Adequacy of spontaneous ventilation was evaluated by determining partial pressure of arterial carbon dioxide 1, 2, and 3 hours after discontinuation of N2O. Extent of vasoactive drug administration for control of intraoperative hypertension (as determined by the clinicians caring for the patients) was described by minutes of vasodilator infusion and milligrams of propranolol or labetalol administered. The frequency of postoperative hypertension was defined as the number of patients in each group who required medication for postoperative hypertension. No significant differences in variables were found for thiopental/sufentanil, thiopental/fentanyl, or isoflurane when these drugs were used with N2O and vecuronium.


CONCLUSIONS
Any one of these balanced anesthetic techniques appears appropriate for craniotomy.
Grundy
B L
BL
Department of Anesthesiology, University of Florida College of Medicine, Gainesville 32610-0254.
Pashayan
A G
AG
Mahla
M E
ME
Shah
B D
BD
D000328:Adult; D000762:Anesthesia Recovery Period; D000769:Anesthesia, Inhalation / Q000379:methods*; D000771:Anesthesia, Intravenous / Q000379:methods*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D003243:Consciousness; D003399:Craniotomy; D004311:Double-Blind Method; D005283:Fentanyl; D006801:Humans; D006973:Hypertension / Q000517:prevention & control; D007431:Intraoperative Complications / Q000517:prevention & control; D007530:Isoflurane; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D012119:Respiration; D017409:Sufentanil; D013874:Thiopental
D000959:Antihypertensive Agents; D017409:Sufentanil; D007530:Isoflurane; D013874:Thiopental; D005283:Fentanyl