[Intravenous anesthesia using propofol during lengthy neurosurgical interventions]

Area of Science:

• Anesthesiology
• Neurosurgery
• Pharmacology

Background:

• Neurosurgery requires careful anesthetic management for hemodynamic stability.
• Long-duration (>3 hours) intracranial surgeries present unique anesthetic challenges.
• Comparing total intravenous anesthesia (TIVA) with propofol versus inhalational anesthesia with isoflurane is crucial for optimizing patient outcomes.

Purpose of the Study:

• To compare hemodynamic stability between propofol-based TIVA and isoflurane anesthesia during long neurosurgeries.
• To evaluate the time to recovery of consciousness after these anesthetic protocols.
• To assess the hypertensive response to orotracheal intubation under both anesthetic regimens.

Main Methods:

• A randomized study of 58 middle-aged patients undergoing intracranial surgery.
• Two groups were formed: isoflurane (n=27) and propofol (n=31).
• Anesthetic induction and maintenance protocols were standardized, with fentanyl, lidocaine, and vecuronium used in both groups.

Main Results:

• Both anesthetic protocols led to a significant decrease in systolic and mean arterial pressures post-induction.
• The propofol group exhibited a significantly lower hypertensive response to orotracheal intubation compared to the isoflurane group.
• Time to recovery of spontaneous breathing and tracheal extubation was significantly shorter in the isoflurane group.

Conclusions:

• Propofol serves as a viable alternative to the thiopental-isoflurane sequence for lengthy neurosurgical procedures.
• Propofol anesthesia is associated with a reduced hypertensive response during intubation.
• While isoflurane offered faster respiratory recovery, propofol provides a valuable option for neuroanesthesia.