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Total intravenous anesthesia: advantages for intracranial surgery
Chad D Cole1, Oren N Gottfried, Dhanesh K Gupta
1Department of Neurosurgery, University of Utah, Salt Lake City, Utah 84132, USA.
Neurosurgery
|January 8, 2008
Summary
Total intravenous anesthesia (TIVA) with propofol may reduce intracranial pressure (ICP) and improve cerebral perfusion during craniotomy. This approach shows comparable hemodynamic stability and recovery times to volatile anesthetics.
Area of Science:
- Anesthesiology
- Neurosurgery
- Critical Care Medicine
Background:
- Volatile anesthetics can increase intracranial pressure (ICP) during neurosurgery, complicating procedures and increasing risks.
- Elevated ICP in craniotomy patients poses challenges for surgeons and increases the risk of ischemic events.
- Total intravenous anesthesia (TIVA) is an alternative anesthetic technique for craniotomy.
Purpose of the Study:
- To evaluate the use of TIVA with propofol and analgesics in patients undergoing craniotomy.
- To compare TIVA with volatile anesthetics regarding hemodynamic stability, ICP, and recovery.
- To assess the effects of TIVA on operative site access and cognitive function.
Main Methods:
- Literature review and institutional experience with TIVA in craniotomy patients.
- Emphasis on hemodynamic parameters, ICP changes, emergence, extubation, and cognitive recovery.
- Analysis of data from prospective, randomized clinical trials comparing TIVA and volatile anesthetics.
Main Results:
- TIVA with propofol demonstrates comparable hemodynamic stability, emergence, extubation, and cognitive function to volatile anesthetics.
- Evidence suggests TIVA decreases ICP and increases cerebral perfusion pressure during elective craniotomy.
- Adverse event profiles are similar between TIVA and volatile anesthetic groups.
Conclusions:
- TIVA with propofol is a viable anesthetic option for craniotomy, potentially offering benefits in ICP management.
- Further research is needed to evaluate TIVA's impact on brain swelling and operative site access in patients with severely elevated ICP.
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