title: A comparison of three anesthetic techniques in patients undergoing craniotomy for supratentorial intracranial surgery.
abstract: Several anesthetic techniques have been used successfully to provide anesthesia for resection of intracranial supratentorial mass lesions. One technique used to enhance recovery involves changing anesthesia from vapor-based to propofol-based for cranial closure. However, there are no data to support a beneficial effect of this approach in the immediate postoperative period after craniotomy. We evaluated 3 anesthetic techniques in 60 patients undergoing elective surgery for supratentorial mass lesions. Patients were randomly assigned to three anesthesia study groups: propofol infusion, isoflurane inhalation, and these two techniques combined. In the combination group, once the dura was closed, isoflurane was discontinued and propofol infusion simultaneously started. We studied intra- and postoperative hemodynamics and several recovery variables for 2 h after the end of anesthesia. Baseline and average intraoperative blood pressure and heart rate values did not differ among the groups. Heart rate and blood pressure increased similarly in all groups in response to intubation and pin placement and postoperatively. None of the recovery event times (open eyes, extubation, follow commands, oriented, Aldrete score) or psychomotor test performance differed significantly. We conclude that the sequential administration of isoflurane and propofol did not provide earlier recovery and cognition than the intraoperative use of isoflurane alone.
  
  
  CONCLUSIONS
  We evaluated three anesthetic techniques with and without propofol in patients undergoing elective surgery for supratentorial mass lesions by using a prospective, randomized clinical study design and found that the three anesthetics did not differ in intra- or postoperative hemodynamic stability or early postoperative recovery variables.
authors.affiliation: Department of Anesthesia and Perioperative Medicine, University of California, San Francisco, California 94143, USA. talkep@anesthesia.ucsf.edu
authors.forename: Pekka
authors.initials: P
authors.lastname: Talke
authors.forename: James E
authors.initials: JE
authors.lastname: Caldwell
authors.forename: Ronald
authors.initials: R
authors.lastname: Brown
authors.forename: Barbara
authors.initials: B
authors.lastname: Dodson
authors.forename: Joan
authors.initials: J
authors.lastname: Howley
authors.forename: Charles A
authors.initials: CA
authors.lastname: Richardson
mesh_terms: D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D000769:Anesthesia, Inhalation / Q000191:economics; D000771:Anesthesia, Intravenous / Q000191:economics; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D003399:Craniotomy; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007530:Isoflurane; D008297:Male; D008875:Middle Aged; D015742:Propofol; D011446:Prospective Studies; D015173:Supratentorial Neoplasms / Q000191:economics / Q000601:surgery*
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D007530:Isoflurane; D015742:Propofol