Effects of Anesthetic Management on Early Postoperative Recovery, Hemodynamics and Pain After Supratentorial Craniotomy.
Various clinical trials have assessed how intraoperative anesthetics can affect early recovery, hemodynamics and nociception after supratentorial craniotomy. Whether or not the difference in recovery pattern differs in a meaningful way with anesthetic choice is controversial. This review examines and compares different anesthetics with respect to wake-up time, hemodynamics, respiration, cognitive recovery, pain, nausea and vomiting, and shivering. When comparing inhalational anesthetics to intravenous anesthetics, either regimen produces similar recovery results. Newer shorter acting agents accelerate the process of emergence and extubation. A balanced inhalational/intravenous anesthetic could be desirable for patients with normal intracranial pressure, while total intravenous anesthesia could be beneficial for patients with elevated intracranial pressure. Comparison of inhalational anesthetics shows all appropriate for rapid emergence, decreasing time to extubation, and cognitive recovery. Comparison of opioids demonstrates similar awakening and extubation time if the infusion of longer acting opioids was ended at the appropriate time. Administration of local anesthetics into the skin, and addition of corticosteroids, NSAIDs, COX-2 inhibitors, and PCA therapy postoperatively provided superior analgesia. It is also important to emphasize the possibility of long-term effects of anesthetics on cognitive function. More research is warranted to develop best practices strategies for the future that are evidence-based.
Department of Anesthesiology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
Eugenia
E
Ayrian
Department of Anesthesiology, Critical Care and Pain Medicine, "Sapienza" University of Rome, Rome, Italy.
Alan David
AD
Kaye
Department of Anesthesiology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
Chelsia L
CL
Varner
Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.
Carolina
C
Guerra
Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA.
Nalini
N
Vadivelu
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA 02115, USA.
Richard D
RD
Urman
Department of Anesthesiology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
Vladimir
V
Zelman
Department of Anesthesiology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
Philip D
PD
Lumb
Department of Anaesthesiology, Critical Care and Pain Medicine, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy.
Giovanni
G
Rosa
Department of Anesthesiology, Critical Care and Pain Medicine, "Sapienza" University of Rome, Rome, Italy ; Department of Anaesthesiology, Critical Care and Pain Medicine, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy.
Federico
F
Bilotta
Anesthesia; Cognitive recovery; Craniotomy; Neuroanesthesia; Postoperative recovery; Supratentorial