Inhalational or intravenous anesthetics for craniotomies? Pro inhalational.
OBJECTIVE
In neurosurgery, anesthesiologists and surgeons focus on the same target - the brain. The nature of anesthetics is to interact with brain physiology, leading to favorable and adverse effects. Research in neuroanesthesia over the last three decades has been dedicated to identifying the optimal anesthetic agent to maintain coupling between cerebral blood flow and metabolism, keep cerebrovascular autoregulation intact, and not increase cerebral blood volume and intracranial pressure.


RESULTS
Sevoflurane is less vasoactive than halothane, enflurane, isoflurane, or desflurane. The context sensitive half-life is short and similar to that of desflurane, which translates into fast on and offset. Compared with propofol, sevoflurane decreases cerebral blood flow to a lesser extent, while cerebral metabolism is suppressed to the same degree. Sevoflurane does not increase intracranial pressure, while propofol decreases intracranial pressure.


CONCLUSIONS
In neurosurgical patients with normal intracranial pressure, sevoflurane might be a good alternative to propofol. In patients with reduced intracranial elastance, caused by space occupying lesions, with elevated intracranial pressure or complex surgical approaches, propofol should remain first choice.
Engelhard
Kristin
K
Klinik für Anästhesiologie, Johannes Gutenberg-Universität, Mainz, Germany. engelhak@uni-mainz.de
Werner
Christian
C
D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation / Q000009:adverse effects / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000009:adverse effects / Q000494:pharmacology*; D001921:Brain / Q000098:blood supply / Q000187:drug effects* / Q000378:metabolism; D002320:Cardiovascular Physiological Phenomena / Q000187:drug effects; D002560:Cerebrovascular Circulation / Q000187:drug effects; D003399:Craniotomy / Q000009:adverse effects; D004569:Electroencephalography; D004827:Epilepsy / Q000139:chemically induced; D006706:Homeostasis / Q000187:drug effects; D006801:Humans; D007427:Intracranial Pressure / Q000187:drug effects; D008738:Methyl Ethers / Q000494:pharmacology; D008991:Monitoring, Physiologic; D018696:Neuroprotective Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D018579:Patient Selection; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced; D015742:Propofol / Q000494:pharmacology; D000077149:Sevoflurane
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D018696:Neuroprotective Agents; D000077149:Sevoflurane; D015742:Propofol