The comparative effects of desflurane and isoflurane on lumbar cerebrospinal fluid pressure in patients undergoing craniotomy for supratentorial tumors.
We compared the effects of desflurane and isoflurane on cerebral perfusion pressure (CPP), lumbar cerebrospinal fluid pressure (LCSFP), and mean arterial blood pressure (MAP) in patients anesthetized with desflurane or isoflurane undergoing craniotomy for supratentorial mass lesions. Additionally, emergence from anesthesia was examined to determine if neurologic function could be assessed earlier after isoflurane or desflurane anesthesia. Thirty-six patients were randomized to receive either desflurane or isoflurane for maintenance of anesthesia at 1.2 minimum alveolar concentration (MAC). Patients were hyperventilated (PaCO(2), 30 +/- 2 mm Hg) after baseline LCSFP was obtained via the subarachnoid catheter. At a MAC of 1.2, mean LCSFP was not statistically different between the two study groups either before or after hyperventilation. Additionally, CPP was not significantly different between the two groups. Finally, patient's time to respond to commands was 50% shorter in the desflurane group (30 +/- 36 min) (mean +/- SD) when compared with the isoflurane group (72 +/- 126 min); however, this was not significant (P = 0.17). In patients undergoing craniotomy for supratentorial mass lesions, desflurane and isoflurane have similar effects on CPP and MAP. Additionally, desflurane in the setting of hyperventilation does not cause significant changes in LCSFP.


CONCLUSIONS
This is the largest study to date comparing the effects of desflurane and isoflurane on patients undergoing craniotomy for supratentorial mass lesion with evidence of midline shift or edema. Neither desflurane nor isoflurane significantly altered lumbar cerebrospinal fluid pressure when moderate hypocapnia was maintained.
Kaye
Alan
A
From the Department of Anesthesiology, Texas Tech University, Lubbock, Texas.
Kucera
Ian J
IJ
Heavner
James
J
Gelb
Adrian
A
Anwar
Muhamed
M
Duban
Marilyn
M
Arif
A Salam
AS
Craen
Rosemary
R
Chang
Cheng-Tao
CT
Trillo
Raul
R
Hoffman
Marc
M
D000368:Aged; D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation; D001794:Blood Pressure / Q000187:drug effects; D015170:Cerebrospinal Fluid Pressure / Q000187:drug effects*; D002560:Cerebrovascular Circulation / Q000187:drug effects; D003399:Craniotomy; D000077335:Desflurane; D005260:Female; D006801:Humans; D007427:Intracranial Pressure / Q000187:drug effects; D007530:Isoflurane / Q000031:analogs & derivatives*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D015173:Supratentorial Neoplasms / Q000150:complications / Q000503:physiopathology / Q000601:surgery*
D018685:Anesthetics, Inhalation; D000077335:Desflurane; D007530:Isoflurane