title: No difference in emergence time and early cognitive function between sevoflurane-fentanyl and propofol-remifentanil in patients undergoing craniotomy for supratentorial intracranial surgery.
abstract: Balanced anesthesia with sevoflurane-fentanyl has been widely accepted as anesthetic management for neurosurgery. Propofol-remifentanil regimen has been successfully used in various surgical settings, but a comprehensive comparison of sevoflurane-fentanyl and propofol-remifentanil anesthesia in patients undergoing craniotomy for supratentorial intracranial surgery has not yet been done. The aim of this prospective, randomized, open-label clinical trial was to compare clinical properties of sevoflurane-fentanyl with propofol-remifentanil anesthesia in patients undergoing supratentorial intracranial surgery. The primary endpoint was to compare early postoperative recovery and cognitive functions within the two groups; we also evaluated hemodynamic events, vomiting, shivering, and pain. One hundred twenty patients (64 males; age 15-75 years) were randomized to either total intravenous anesthesia (group T) or sevoflurane anesthesia (group S). Emergence and extubation times and cognitive function (Short Orientation Memory Concentration Test [SOMCT]) were compared in the two groups. Brain swelling, incidence of hypotensive and hypertensive episodes, postoperative vomiting, shivering, and pain were also analyzed. The mean emergence time (12.2 +/- 4.9 minutes for group S versus 12.3 +/- 6.1 minutes for group T; P = 0.92) and extubation time (18.2 +/- 2.3 minutes for group S versus 18.3 +/- 2.1 minutes for group T; P = 0.80) were similar in the two groups. Average SOMCT scores, both 15 minutes after extubation (25.6 +/- 4.9 in group S versus 23.9 +/- 7.5 in group T; P = 0.14) and 45 minutes after extubation (27.3 +/- 2.2 in group S versus 26.0 +/- 5.1 in group T; P = 0.07) were also comparable. Brain swelling was present in seven and five patients in groups S and T, respectively (P = 0.76). Hypotension was present in 12% (group S) and 28% (group T) of patients (P = 0.02). Hypertension was present in 17% of patients in group S and 40% of patients in group T (P = 0.0046). Shivering was present in 18% and 25% of patients in groups T and S (P = 0.37). Our study demonstrates that there is no patient benefit of using total intravenous anesthesia with an ultra-short-acting opioid over the conventional balanced volatile technique in terms of recovery and cognitive functions.
authors.affiliation: Department of Anesthesia and Intensive Care, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy. gmagni@yahoo.com
authors.forename: G
authors.initials: G
authors.lastname: Magni
authors.forename: F
authors.initials: F
authors.lastname: Baisi
authors.forename: I
authors.initials: I
authors.lastname: La Rosa
authors.forename: C
authors.initials: C
authors.lastname: Imperiale
authors.forename: V
authors.initials: V
authors.lastname: Fabbrini
authors.forename: M L
authors.initials: ML
authors.lastname: Pennacchiotti
authors.forename: G
authors.initials: G
authors.lastname: Rosa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D018685:Anesthetics, Inhalation / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D003071:Cognition / Q000187:drug effects*; D003399:Craniotomy; D023381:Endpoint Determination; D005260:Female; D005283:Fentanyl / Q000009:adverse effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects; D008875:Middle Aged; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures; D011183:Postoperative Complications / Q000523:psychology*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D015742:Propofol / Q000009:adverse effects; D011446:Prospective Studies; D000077149:Sevoflurane; D015173:Supratentorial Neoplasms / Q000601:surgery*
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D005283:Fentanyl; D015742:Propofol