Anesthesia for craniotomy: total intravenous anesthesia with propofol and alfentanil compared to anesthesia with thiopental sodium, isoflurane, fentanyl, and nitrous oxide.
OBJECTIVE
To compare a total intravenous (IV) anesthetic technique based on propofol and alfentanil with a commonly used anesthetic technique for craniotomy.


METHODS
Open-label, randomized, clinical study.


METHODS
Neurosurgical clinic at a university hospital.


METHODS
Forty patients, aged 18 to 55 years, scheduled for brain tumor surgery.


METHODS
In 20 patients, anesthesia was induced with fentanyl and thiopental sodium and maintained with fentanyl, dehydrobenzperidol, isoflurane, nitrous oxide (N2O), and a thiopental sodium infusion. Twenty patients were anesthetized with a propofol loading infusion followed by a maintenance infusion at a fixed rate. In addition, alfentanil was administered as a loading bolus, followed by a variable-rate infusion, with additional doses as necessary to maintain hemodynamic stability.


RESULTS
A decrease in blood pressure (BP) after induction with thiopental sodium was followed by a significant increase in BP and heart rate (HR) during intubation. BP and HR did not change during the propofol loading infusion. However, the administration of alfentanil was followed by a similar decrease in BP with a return to baseline values during the intubation period. Return of normal orientation (7 +/- 5 minutes vs 27 +/- 23 minutes) and concentration (12 +/- 12 minutes vs 35 +/- 37 minutes) was shorter and more predictable for the propofol-alfentanil-treated patients than for the thiopental sodium patients. Maintenance propofol concentration (nine patients) was between 3 +/- 0.69 micrograms/ml and 3.36 +/- 1.17 micrograms/ml, while the concentration at awakening was 1.09 microgram/ml. Alfentanil concentration at extubation (nine patients) was 79 +/- 34 ng/ml.


CONCLUSIONS
A total IV anesthetic technique with propofol and alfentanil is a valuable alternative to a more commonly used technique based on thiopental sodium, N2O, fentanyl, and isoflurane.
Van Hemelrijck
J
J
Department of Anesthesiology, Katholieke Universiteit Leuven, Belgium.
Van Aken
H
H
Merckx
L
L
Mulier
J
J
D000328:Adult; D015760:Alfentanil; D000771:Anesthesia, Intravenous; D001932:Brain Neoplasms / Q000601:surgery; D003399:Craniotomy; D005260:Female; D005283:Fentanyl; D006801:Humans; D007530:Isoflurane; D008297:Male; D008875:Middle Aged; D009609:Nitrous Oxide; D015742:Propofol; D013874:Thiopental
D015760:Alfentanil; D007530:Isoflurane; D013874:Thiopental; D009609:Nitrous Oxide; D005283:Fentanyl; D015742:Propofol