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北京天坛医院麻醉科 赵岩

A Comparison Between Sevoflurane and Desflurane Anesthesia in Patients Undergoing Craniotomy for Supratentorial Intracranial Surgery ANESTHESIA & ANALGESIA vol. 109,No. 2, August 2009. 北京天坛医院麻醉科 赵岩. BACKGROUND. Desflurane allows for early recovery after anesthesia.

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北京天坛医院麻醉科 赵岩

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  1. A Comparison BetweenSevoflurane andDesfluraneAnesthesia in Patients Undergoing Craniotomy forSupratentorial Intracranial SurgeryANESTHESIA & ANALGESIAvol. 109,No. 2, August 2009 北京天坛医院麻醉科 赵岩

  2. BACKGROUND • Desflurane allows for early recovery after anesthesia. • Its use in neurosurgery may be attractive. • The use of desflurane in neurosurgery has been debated

  3. BACKGROUND • No variation in ICP in normocapnic patients undergoing removal of supratentorial tumors using desflurane anesthesia • There are no large studies directly comparing these drugs in patients undergoing neurosurgical resection of supratentorial tumors.

  4. PURPOSE • early postoperative recovery and cognitive function within the two groups • we also evaluated ----------complications.

  5. OBJECT • 120patients • ASA I–III (66 men) • Glascow Coma Scale 15 • undergoing craniotomy for supratentorial expanding lesions

  6. Exclusion • Pregnancy • allergies to any anesthetic drug • Glasgow Coma Scale ＜15 • obesity (body mass index ＞30) • history of drug or alcohol abuse • refusal to sign consent.

  7. METHOD 120 patients Group S (60 patients) Group D (60 patients) dexamethasone 10 mg saline solution 10 mL/kg midazolam 0.03 mg/kg VAS propofol (3 mg/kg) fentanyl (3 ug/kg) vecuronium (0.1 mg/kg) Sevoflurane 1.2 MAC vecuronium Desflurane 1.2 MAC vecuronium ketorolac30 mg labetalol 100 mg

  8. 主要观察指标 • brain relaxation • Emergence time • Tracheal extubation time • Recovery time • Cognitive behavior (SOMCT) • Blood samples for gas analysis

  9. 其他观察指标 • shivering • postoperative nausea and vomiting • the request for analgesic medications • Hypotension and hypertension • tachycardia and bradycardia • respiratory complications

  10. RESULTS

  11. SOMCT requires subjects to recall the current year and month, the details of a short story, and to repeat in numerical order and reverse order the sequence of the months of the year. These five questions yielded scores ranging from 0 to 28, with higher scores indicating better function and scores more than 20 were considered normal.

  12. DISCUSSION • Our study shows that maintenance of anesthesia with desflurane resulted in a faster recovery compared with sevoflurane. • it might help distinguish which patient has a new neurological deficit and would therefore require a specialized diagnostic test or even emergent reintervention.

  13. the evaluation obtained 15 min after tracheal extubation, when the SOMCT score suggesting a faster recovery in the desflurane group. • The SOMCT score in the two groups were similar at 30 min after tracheal extubation and remained comparable over the next 2 h.

  14. A 15 min difference in recovery of almost complete cognitive capacity would not be crucial in modifying medical strategies, such as requiring a pecialized diagnostic test or even an emergent reintervention. • The advantages of rapid recovery from desflurane anesthesia may be tempered by the effects of desflurane on cerebral perfusion pressure and ICP.

  15. In 13 patients (11%, 6 sevoflurane and 7 desflurane), intracranial volume was graded as severely abnormal at dural opening and therapy was necessary to decrease severe brain swelling. • our study was not powered to detect differences in brain relaxation between the two anesthetic strategies.

  16. We did not measure ICP or cerebrospinal fluid pressure during surgery. (Turner et al. reported that there is a poor correlation between lumbar cerebrospinal fluid pressure and brain relaxation for pressure values within the normal range. ) • We relied on clinical evaluation because we wanted to test how the two anesthetics influenced brain relaxation during surgical operation in the usual clinical scenario.

  17. Our study did not address the effects of desflurane or sevoflurane in patients with severe intracranial hypertension. • Our patient population, in common with many neurosurgical practices, included a majority of patients who had well compensated ICP.

  18. CONCLUSION • patients who received desflurane had a shorter extubation and early recovery time but similar intraoperative and postoperative incidence of complications compared with those who received sevoflurane.

  19. thank you

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