title: The effects of sevoflurane and propofol on cerebral hemodynamics during intracranial tumors surgery under monitoring the depth of anesthesia.
abstract: Hemodynamic effects during cerebral tumor resection surgery under monitoring the depth of anesthesia and during recovery in sevoflurane- or propofol-anesthetized patients have not been previously compared.
  
  
  OBJECTIVE
  To compare cerebral hemodynamic changes using transcranial Doppler sonography during sevoflurane or propofol anesthesia under state entropy (SE) monitoring, and during recovery period.
  
  
  METHODS
  In a randomized manner, 130 patients received sevoflurane (group T-S) or propofol (group T-P) to maintain SE at 40-50. Cerebral blood flow velocity (Vmean) in the middle cerebral artery was evaluated at baseline, after tracheal intubation, opening of the dura mater, tumor resection, skin closure, extubation, and two hours after extubation. Cerebrovascular resistance index (RAP), estimated cerebral perfusion pressure (eCPP), and cerebral blood flow index (CBFI) were calculated off-line.
  
  
  RESULTS
  During surgery SE was 40.6 (SD, 8.1) in the group T-S and 44.0 (SD, 7.4) in the group T-P. Blood pressure was significantly higher in the group T-P. Compared to the baseline, Vmean decreased by 16.6% and 23.5% in the groups T-S and T-P, respectively (P<0.05). RAP and eCPP were higher in the group T-P versus the group T-S: 28.9% and 5.2%, respectively, above the baseline for RAP (P<0.005) and 3.2% and 16.9% below the baseline for eCPP (P<0.005). CBFI was below the baseline by 20.1% and 24.0% in the groups T-S and T-P, respectively (P>0.05). After the extubation and 2 hours later, Vmean recovered comparably with no differences in RAP, eCPP, or CBFI between the two groups.
  
  
  CONCLUSIONS
  At the comparable depth of anesthesia for intracranial tumors surgery and during recovery, sevoflurane had no major effect on cerebral circulation measured by transcranial Doppler sonography as compared with propofol. Our results add to current knowledge on the safety of sevoflurane in neuroanesthesia.
authors.affiliation: Department of Anesthesiology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, Kaunas, Lithuania. gediminasbanevicius@yahoo.com
authors.forename: Gediminas
authors.initials: G
authors.lastname: Banevičius
authors.forename: Danguolė
authors.initials: D
authors.lastname: Rugytė
authors.forename: Andrius
authors.initials: A
authors.lastname: Macas
authors.forename: Arimantas
authors.initials: A
authors.lastname: Tamašauskas
authors.forename: Edgaras
authors.initials: E
authors.lastname: Stankevičius
mesh_terms: D000293:Adolescent; D000328:Adult; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D001783:Blood Flow Velocity / Q000187:drug effects; D001921:Brain / Q000601:surgery*; D001932:Brain Neoplasms / Q000601:surgery*; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008738:Methyl Ethers / Q000494:pharmacology*; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000187:drug effects; D016343:Monitoring, Intraoperative; D011184:Postoperative Period; D015742:Propofol / Q000494:pharmacology*; D011446:Prospective Studies; D000077149:Sevoflurane; D017585:Ultrasonography, Doppler, Transcranial; D055815:Young Adult
chemical_list: D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D015742:Propofol