title: Effect of propofol and sevoflurane on the inflammatory response of patients undergoing craniotomy.
abstract: BACKGROUND
  The purpose of this randomised, single-centre study was to prospectively investigate the impact of anaesthetic techniques for craniotomy on the release of cytokines IL-6, IL-8, IL-10, and to determine whether intravenous anaesthesia compared to inhalational anaesthesia attenuates the inflammatory response.
  
  
  METHODS
  The study enroled 40 patients undergoing craniotomy, allocated into two equal groups to receive either sevoflurane (n = 20) or propofol (n = 20) in conjunction with remifentanil and rocuronium. The lungs were ventilated mechanically to maintain normocapnia. Remifentanil infusion was adjusted according to the degree of surgical manipulation and increased when mean arterial pressure and the heart rate increased by more than 30 % from baseline. The depth of anaesthesia was adjusted to maintain a bispectral index (BIS) of 40-60. Invasive haemodynamic monitoring was used. Serum levels of IL-6, IL-8 and IL-10 were measured before surgery and anaesthesia, during tumour removal, at the end of surgery, and at 24 and 48 h after surgery. Postoperative complications (pain, vomiting, changes in blood pressure, infection and pulmonary, cardiovascular and neurological events) were monitored during the first 15 days after surgery.
  
  
  RESULTS
  Compared with patients anaesthetised with sevoflurane, patients who received propofol had higher levels of IL-10 (p = 0.0001) and lower IL-6/IL-10 concentration ratio during and at the end of surgery (p = 0.0001). Both groups showed only a minor response of IL- 8 during and at the end of the surgery (p = 0.57).
  
  
  CONCLUSIONS
  Patients who received propofol had higher levels of IL-10 during surgery. Neither sevoflurane nor propofol had any significant impact on the occurrence of postoperative complications. Our findings should incite future studies to prove a potential medically important anti-inflammatory role of propofol in neuroanaesthesia.
  
  
  BACKGROUND
  Identified as NCT02229201 at www.clinicaltrials.gov.
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Zaloska 7, Ljubljana, SI-1000, Slovenia. jasmina.markovic1@kclj.si.
authors.forename: Jasmina
authors.initials: J
authors.lastname: Markovic-Bozic
authors.affiliation: Faculty of Natural Science and Engineering, University of Ljubljana, Ljubljana, Slovenia.
authors.forename: Blaz
authors.initials: B
authors.lastname: Karpe
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Zaloska 7, Ljubljana, SI-1000, Slovenia.
authors.forename: Iztok
authors.initials: I
authors.lastname: Potocnik
authors.affiliation: Institute of Clinical Chemistry and Biochemistry, University Medical Centre Ljubljana, Ljubljana, Slovenia.
authors.forename: Ales
authors.initials: A
authors.lastname: Jerin
authors.affiliation: Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana, Slovenia.|Service de Neurochirurgie, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
authors.forename: Andrej
authors.initials: A
authors.lastname: Vranic
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Zaloska 7, Ljubljana, SI-1000, Slovenia.
authors.forename: Vesna
authors.initials: V
authors.lastname: Novak-Jankovic
mesh_terms: D000328:Adult; D000368:Aged; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D003399:Craniotomy / Q000009:adverse effects / Q000639:trends; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006801:Humans; D018836:Inflammation Mediators / Q000037:antagonists & inhibitors / Q000097:blood*; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage*; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies; D000077149:Sevoflurane; D016896:Treatment Outcome
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D018836:Inflammation Mediators; D008738:Methyl Ethers; D000077149:Sevoflurane; D015742:Propofol
keywords: Craniotomy; Interleukin 10; Interleukin 6; Interleukin 8; Propofol; Sevoflurane