Propofol vs isoflurane for neurosurgical anesthesia in Thai patients.
Sixty Thai patients, ASA class I-II, Glasgow coma score of 15 undergoing elective intracranial surgery were randomly assigned to 2 groups. In group I, 30 patients were induced with thiopental 3-5 mg/kg, intubation with succinylcholine 1-2 mg/kg and then maintained with 60 per cent N2O in O2, isoflurane and vecuronium as a muscle relaxant. In group II, 30 patients received fentanyl 50 micrograms, propofol 1.0-2.5 mg/kg for induction and vecuronium 0.08 mg/kg for intubation then maintained with 60 per cent N2O in O2, continuous infusion of propofol 2-12 mg/kg/h and vecuronium as a muscle relaxant. Controlled ventilation in both groups was set to maintain PET CO2 in the range of 28-35 mmHg. 3 patients (1 in group I and 2 in group II) were excluded from the study due to surgical problems. There was no statistical difference in age, sex, ASA status, weight, duration of anesthesia. Group II had a more stable systolic BP, Diastolic BP and Pulse rate than Group I during induction and emergence from anesthesia. Glasgow coma scores in the recovery period, Group II had higher scores than Group I at 5 and 15 minutes but not at 30 minutes. Mean recovery times (eye opening) was 14.03 +/- 4.85 minutes in group I which is significantly different from 10 +/- 5.17 minutes in group II. The cost of anesthesia in group II was 1.3 times that of group I. In conclusion, although neurosurgical anesthesia for Thai patients with fentanyl-propofol technique produces more stable blood pressure during intubation and emergence, rapid recovery from anesthesia and a higher Glasgow coma score, the cost of anesthesia is more expensive. Furthermore, this technique is more difficult and needs more experience.
Ittichaikulthol
W
W
Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Pausawasdi
S
S
Srichintai
P
P
Sarnvivad
P
P
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation / Q000008:administration & dosage* / Q000191:economics; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000191:economics; D001794:Blood Pressure / Q000187:drug effects; D016009:Chi-Square Distribution; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000191:economics; D015600:Glasgow Coma Scale; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage* / Q000191:economics; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery; D015742:Propofol / Q000008:administration & dosage* / Q000191:economics; D013785:Thailand; D013874:Thiopental / Q000008:administration & dosage / Q000191:economics
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D007530:Isoflurane; D013874:Thiopental; D005283:Fentanyl; D015742:Propofol