Despite the theoretical benefits of i.v. agents, volatile agents remain popular. In a study comparing desflurane, isoflurane, and sevoflurane in a porcine model of intracranial hypertension, at equipotent doses and normocapnia, cerebral blood flow (CBF) and ICP were least with sevoflurane. Propofol is the most commonly used intravenous anesthetic. It has many theoretical advantages by reducing cerebral blood volume (CBV) and ICP and preserving both autoregulation and vascular reactivity. Neurosurgical patients anaesthetized with propofol were found to have lower ICP and higher CPP than those anaesthetized with isoflurane or sevoflurane. The well known pharmacodynamic advantages of intravenous anesthetics may give this group of drugs superior cerebral effects when compared with inhalation anesthetics.
The aim of this study is to evaluate the cerebral hemodynamics and global cerebral oxygenation as well as the systemic hemodynamic changes using midazolam and propofol as total intravenous anesthetics (TIVA) in comparison with sevoflurane anesthesia in clipping of ruptured cerebral aneurysm.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
50
Propofol (1.5-2 mg/kg/h) infusion, Midazolam (0.12 mg/kg/h) infusion
Sevoflurane at a concentration of 2-2.5%
Fentanyl in repeated doses (50 µg) when needed (heart rate or mean arterial blood pressure increase more than 20% of the basal value) are used for maintenance of analgesia
Sherif A Mousa
Al Mansurah, DK, Egypt
Arterio-Jugular oxygen content difference
The differences between arterial and jugular bulb oxygen contents
Time frame: Immediately before and every 30 min for 6 hour following start of surgery
Estimated cerebral metabolic rate for O2 (eCMRO2)
eCMRO2=Ca- jO2 x(PaCO2 ∕ 100), Where Ca jO2 is arterio-jugular O2 content difference. PaCO2 is arterial CO2 tension
Time frame: Immediately before and every 30 min for 6 hour following start of surgery
Cerebral Extraction Rate of O2 (CEO2)
Calculated as the differences between arterial and jugular bulb O2 saturations, CEO2 = SaO2 - SjvO2
Time frame: Immediately before and every 30 min for 6 hour following start of surgery
Cerebral Blood Flow equivalent (CBFe)
: Which is an index of flow metabolism relationship, calculated as a reciprocal of arterio-jugular O2 content difference. CBFe = 1 ∕CaO2-CjvO.
Time frame: Immediately before and every 30 min for 6 hour following start of surgery
Heart rate
Time frame: Immediately before and every 30 min for 6 hour following start of surgery
Mean arterial blood pressure
Time frame: Immediately before and every 30 min for 6 hour following start of surgery
Peripheral oxygen saturation
Time frame: Immediately before and every 30 min for 6 hour following start of surgery
Central venous pressure
Time frame: Immediately before and every 30 min for 6 hour following start of surgery
End tidal carbon dioxide tension
Time frame: Immediately before and every 30 min for 6 hour following start of surgery
Sedation score
\- Postoperative level of sedation of all patients will be evaluated using Ramsay sedation scale
Time frame: For 6 hours from induction of anesthesia
Time for first analgesic request from extubation
Time for first analgesic request from extubation
Time frame: For 6 hours from induction of anesthesia
Duration of stay in intensive care unit
Time frame: For 5 days after surgery
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