ICP is lower during propofol anaesthesia compared to isoflurane and sevoflurane.
OBJECTIVE
Propofol is a cerebral vasoconstrictor while inhalation anaesthetics like isoflurane and sevoflurane act as cerebral vasodilators in both animal and human studies. This difference of action upon cerebral vessels might implicate a lower ICP during propofol anaesthesia. Cerebral metabolism is decreased by all three anaesthetics. In a prospective, randomised multicenter study ICP was compared during anaesthesia with propofol, isoflurane and sevoflurane.


METHODS
117 patients subjected to elective craniotomy for supratentorial tumour. Propofol: N = 41; isoflurane: N = 38; sevoflurane: N = 38. Nitrous oxide was omitted and all anaesthetics were supplemented with a continuous infusion of fentanyl. ICP was measured subdurally after removal of the bone flap. MABP, CPP, PCO2, AVDO2, rectal temperature, tumour size and midline shift were registered too.


METHODS
Kruskal-Wallis Variance on Ranks. All values in medians with range. P < 0.05 was considered significant.


RESULTS
ICP (mmHg): propofol 7 (-1-20), isoflurane 12 (1-29), sevoflurane 11 (2-32). ICP was significantly lower in the propofol group compared to the isofluane and sevoflurane groups. CPP (mmHg): propofol 80 (45-104), isoflurane 60 (32-84), sevoflurane 63 (44-77). CPP was significantly higher in the propofol group compared to the isoflurane and sevoflurane groups. AVDO2 (mmol/l): propofol 3.1 (0.9-5.1), isoflurane 2.5 (1.1-4.5), sevoflurane 2.6 (0.8-4.1). AVDO2 was significantly higher in the propofol group compared to the isoflurane and sevoflurane groups. No significant differences in PCO2, rectal temperature, tumour size and midline shift were found.


CONCLUSIONS
Subdural ICP is significantly lower during propofol anaesthesia compared to isoflurane and sevoflurane anaesthesia. CPP and AVDO2 are significantly higher during propofol anaesthesia compared to isoflurane and sevoflurane anaesthesia.
Petersen
K D
KD
Department of Anaesthesia and Neurosurgery, Aarhus University Hospital, Denmark.
Landsfeldt
U
U
Cold
G E
GE
Pedersen
C B
CB
Mau
S
S
Hauerberg
J
J
Holst
P
P
D000328:Adult; D000368:Aged; D000771:Anesthesia, Intravenous / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects; D001824:Body Constitution; D003399:Craniotomy; D005260:Female; D006801:Humans; D007427:Intracranial Pressure / Q000187:drug effects / Q000502:physiology*; D007530:Isoflurane / Q000008:administration & dosage*; D008279:Magnetic Resonance Imaging; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage*; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D015742:Propofol / Q000008:administration & dosage*; D000077149:Sevoflurane; D015173:Supratentorial Neoplasms / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed
D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D007530:Isoflurane; D010100:Oxygen; D015742:Propofol