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Preoxygenation Techniques for Tracheal Intubation in Critically Ill Adults Utilizing Oxygen Mask and Noninvasive Ventilation

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Does hyperventilation improve operating condition during supratentorial craniotomy? A multicenter randomized

Adrian W Gelb¹, Rosemary A Craen, G S Umamaheswara Rao

¹Department of Anesthesia and Perioperative Care, University of California San Francisco, 521 Parnassus Ave, C 450, San Francisco, CA 94143-0648, USA. gelba@anesthesia.ucsf.edu

Anesthesia and Analgesia

|January 30, 2008

Summary

This summary is machine-generated.

Intraoperative hyperventilation significantly reduces brain bulk and intracranial pressure (ICP) in patients undergoing supratentorial brain tumor removal. This neuroanesthetic technique improves surgical conditions by decreasing brain swelling.

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Published on: March 26, 2020

Area of Science:

Neurosurgery
Anesthesiology
Neurocritical Care

Background:

Hyperventilation is a common neuroanesthetic practice, but its efficacy in reducing brain bulk and intracranial pressure (ICP) requires further validation.
Craniotomy for supratentorial brain tumors presents challenges related to brain swelling and elevated ICP during surgery.

Purpose of the Study:

To evaluate the impact of moderate hyperventilation (hypocapnia) versus normocapnia on surgeon-assessed brain bulk and measured ICP.
To assess the effectiveness of hyperventilation as a neuroanesthetic technique in patients with supratentorial brain tumors.

Main Methods:

A two-period, crossover, randomized trial involving 275 adult patients with supratentorial brain tumors.
Patients were randomized to sequences of hyperventilation (PaCO2 = 25 +/- 2 mm Hg) and normoventilation (PaCO2 = 37 +/- 2 mm Hg).
ICP was measured, and neurosurgeons blinded to the treatment assessed brain bulk using a four-point scale.

Main Results:

Hyperventilation decreased the risk of increased brain bulk by 45% (P = 0.004), with a number needed to treat of 8.
Mean ICP was significantly lower during hyperventilation (12.3 +/- 8.1 mm Hg) compared to normoventilation (16.2 +/- 9.6 mm Hg) (P < 0.001).
The anesthetic regimen (propofol vs. isoflurane) did not influence brain bulk assessment or ICP.

Conclusions:

Intraoperative moderate hyperventilation is effective in improving surgeon-assessed brain bulk in patients with supratentorial brain tumors.
The observed improvement in brain bulk during hyperventilation is associated with a significant reduction in intracranial pressure.