Comparison of propofol alone vs propofol-phenylephrine combination for intraoperative hemodynamic stability in glioma...

Propofol is widely used for induction in glioma surgery for its neuroprotective effects and favorable recovery profile. However, its dose-dependent hypotension is a major limitation in procedures requiring stable cerebral perfusion.

To compare the efficacy of propofol vs propofol-phenylephrine (PPE) combination in maintaining hemodynamic stability in patients undergoing glioma surgery.

Ninety American Society of Anesthesiologists I-II patients scheduled for elective glioma surgery were randomized to receive either propofol (group P) or a PPE admixture (group PPE). Induction was performed with slow titration of the study drug until loss of verbal response and Bispectral index < 60, followed by a continuous infusion (50 μg/kg/minute) until skin closure. Hemodynamic parameters [mean arterial pressure (MAP), systolic blood pressure, diastolic blood pressure, and heart rate] were recorded at baseline, during induction, immediately after intubation, and at predefined intraoperative time points. The incidence of hypotension, vasopressor and esmolol use, and brain relaxation scores were compared.

Group PPE demonstrated significantly better preservation of MAP, systolic blood pressure, diastolic blood pressure, and heart rate throughout the peri-induction and intraoperative periods (P < 0.05). The mean maximum MAP reduction during induction was greater in group P compared with group PPE (19.7 mmHg vs 12.5 mmHg; P < 0.01). Hypotensive episodes were significantly more frequent in group P than in group PPE (84.4% vs 6.7%; P < 0.001). Rescue phenylephrine requirements were markedly lower in group PPE (P < 0.001). Esmolol use and brain relaxation scores were comparable between groups.

Adding phenylephrine to propofol for induction and maintenance provides superior hemodynamic stability without compromising brain relaxation in glioma surgery.