title: Effect of intraoperative brain protection with propofol on postoperative cognition in patients undergoing temporary clipping during intracranial aneurysm surgery.
abstract: BACKGROUND
  Cognitive dysfunction after subarachnoid hemorrhage (SAH) has been attributable to presence of subarachnoid blood, hydrocephalus (HCP), cerebral edema, vasospasm, and temporary clipping of intracranial aneurysm. Provision of neuroprotection during temporary clipping may improve postoperative cognition in such patients.
  
  
  METHODS
  Good-grade aneurysmal SAH patients undergoing temporary clipping during surgery were allocated either to group C (control) or group P (propofol). Patients in group P received propofol in titrated doses to attain a burst suppression ratio of 75 ± 5% on bispectral index (BIS) monitor. The cognitive function as assessed by Hindi-language modification of mini-mental state examination (HMSE) score was evaluated preoperatively, 24 h after surgery, and at discharge from hospital. A score of ≤23 was indicative of cognitive dysfunction. Perioperative complications, duration of intensive care unit (ICU) and hospital stay, and outcome at discharge were noted.
  
  
  RESULTS
  A total of 66 patients (32 and 34 in group C and P respectively) were included in the study. 97% of the patients had anterior circulation aneurysms. At 24 h after surgery, eight and 12 patients in group C and P respectively; and at discharge, five patients in each group had cognitive dysfunction. In both groups, the trend showed a decline in cognition at 24 h followed by improvement at discharge. Glasgow outcome score in both the groups was comparable (P > 0.05). Intraoperative brain bulge, postoperative vasospasm, and cerebral infarction were found to be independent risk factors for cognitive dysfunction.
  
  
  CONCLUSIONS
  Pharmacologic neuroprotection with propofol at the time of temporary clipping during surgery for aneurysmal SAH did not offer any advantage as far as preservation of cognition is concerned.
authors.forename: Charu
authors.initials: C
authors.lastname: Mahajan
authors.forename: Rajendra Singh
authors.initials: RS
authors.lastname: Chouhan
authors.affiliation: Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Girija Prasad
authors.initials: GP
authors.lastname: Rath
authors.forename: Hari Hara
authors.initials: HH
authors.lastname: Dash
authors.forename: Ashish
authors.initials: A
authors.lastname: Suri
authors.forename: P Sarat
authors.initials: PS
authors.lastname: Chandra
authors.forename: Aman
authors.initials: A
authors.lastname: Mahajan
mesh_terms: D000328:Adult; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000494:pharmacology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018696:Neuroprotective Agents / Q000008:administration & dosage / Q000494:pharmacology*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011184:Postoperative Period; D015742:Propofol / Q000008:administration & dosage / Q000494:pharmacology*; D013345:Subarachnoid Hemorrhage / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D018686:Anesthetics, Intravenous; D018696:Neuroprotective Agents; D015742:Propofol