title: Recovery from anesthesia after craniotomy for supratentorial tumors: comparison of propofol-remifentanil and sevoflurane-sufentanil (the PROMIFLUNIL trial).
abstract: BACKGROUND
  Rapid recovery after supratentorial tumors (STT) removal is important. Short-acting anesthetics, such as propofol and remifentanil might favor this objective. The aim of this study was to compare the recovery of 2 Bispectral index (BIS)-guided anesthesia protocols combining sevoflurane-sufentanil (SS) or propofol-remifentanil (PR) administered during craniotomy for STT.
  
  
  METHODS
  After IRB approval and written consent, patients scheduled for surgical removal of STT were randomized to receive PR or SS. Anesthesia was adjusted to maintain BIS values between 45 and 55. The primary outcome was the time from discontinuation of anesthetics to extubation. Secondary endpoints were: time to respond to a simple order, and to achieve spontaneous ventilation, agitation score at emergence, postoperative Mini Mental State, postoperative Aldrete score, pain Visual Analogical Score, simplified sedation score, Glasgow Coma Scale, and surgical complications. Statistical analyses were performed using analysis of variance.
  
  
  RESULTS
  Thirty-five and 31 were included in the SS and PR groups, respectively. Times to extubation was not different between the 2 groups (11.8±6.9 vs. 13.0±8.1 min in PR and SS groups, respectively, P=0.577). Although times to achieve an Aldrete score to 10, a Glasgow Coma Scale to 15, and a MMS to 30 significantly were lower in SS group, no significant difference was found when analyzing time course of these 3 factors over the first postoperative day. All other secondary endpoints were not different between the 2 groups.
  
  
  CONCLUSIONS
  During craniotomy for STT, we could not demonstrate a reduction in the time to extubation when comparing a BIS-guided anesthesia associating PR to a BIS-guided anesthesia associating SS (Clinicatrials.gov identifier: NCT00389883).
authors.affiliation: *Department of Anesthesiology, Intensive care and Pain Management, Beaujon University Hospital, Clichy ‡Department d'Epidémiologie et Recherche Clinique, Paris ∥Department of Anesthesiology and Intensive Care, University Hospitals of Besançon, Besançon #Department of Anesthesiology, Intensive Care and Pain Management, Robert Debré University Hospital †Faculté de Médecine Denis DIDEROT (Paris VII), Paris ¶Faculté de Médecine de Besançon, Besançon **UMR INSERM U 676, Robert Debré University Hospital §INSERM, CIE 801, Paris, France.
authors.forename: Skander
authors.initials: S
authors.lastname: Necib
authors.forename: Florence
authors.initials: F
authors.lastname: Tubach
authors.forename: Clarisse
authors.initials: C
authors.lastname: Peuch
authors.forename: Eric
authors.initials: E
authors.lastname: LeBihan
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Samain
authors.forename: Jean
authors.initials: J
authors.lastname: Mantz
authors.forename: Souhayl
authors.initials: S
authors.lastname: Dahmani
mesh_terms: D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D001279:Atracurium / Q000031:analogs & derivatives; D056805:Consciousness Monitors; D003399:Craniotomy; D004311:Double-Blind Method; D005260:Female; D015600:Glasgow Coma Scale; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents; D019635:Neurosurgical Procedures / Q000379:methods; D010880:Piperidines; D015742:Propofol; D000077208:Remifentanil; D000077149:Sevoflurane; D017409:Sufentanil; D015173:Supratentorial Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D003473:Neuromuscular Nondepolarizing Agents; D010880:Piperidines; D001279:Atracurium; D000077149:Sevoflurane; D017409:Sufentanil; D000077208:Remifentanil; C101584:cisatracurium; D015742:Propofol