In the current study the investigators intend to evaluate the mode of anesthesia on ischemia modified albumin and outcome in patients with traumatic brain injury undergoing emergency craniotomy
After obtaining Institutional Ethical Committee approval and written informed consent from legally acceptable representative relatives, patients with traumatic brain injury, aged from 18- 60 years old, ASA from (I-III), GCS more than 8 undergoing emergency craniotomy surgery will be selected for this prospective randomized Study. The anesthesia will be induced with 2mcg/kg fentanyl and 2 mg/kg propofol. Muscle relaxation will be achieved with 0.5 mg/kg atracurium. Anesthesia will be maintained with: * Group I, isoflurane (mac\<1) mixed with oxygen 40% and fentanyl 1mcg/kg hourly. * Group PD, propofol infusion(100-150mcg/kg/min) and dexmedetomedine 0.3mcg/kg /h. Parameters will be assessed Preoperative period * Ischemia modified albumin level from venous sample. * Basal Systolic blood pressure, diastolic blood pressure. Mean arterial blood pressure, oxygen saturation, heart rate. * GCS. Intraoperative period * Systolic blood pressure, diastolic blood pressure. Mean arterial blood pressure, oxygen saturation, heart rate after intubation, 5,15,30,60,90min and after extubation. * Need for resuscitation with vasoactive drugs. * Brain relaxation score at dural opening and closure. * ICP * Intraoperative blood loss. * Amount of fluid and blood transfusion. Postoperative period * Ischemia modified albumin immediately postoperatively, after 6h and after 24 hours. * Type of surgery. * Duration of surgery. * Extubation time. * Recovery scores (Ramsay sedation score and modified Alderte score). * GCS immediately postoperatively, after 6h, after 24h and after 48 hours. * Total analgesic requirement during the first 24 hours. * Need for ICU admission. * Length of ICU stay. * Complications. * 28 day mortality.
Study Type
OBSERVATIONAL
Enrollment
54
ischemia modified albumin
Plasma Level of ischemia modified albumin
Time frame: change from preoperative level of ischemia modified albumin at the first 24 hours postoperatively
Glascow Coma Scale
Glascow Coma Scale records the state of a person's consciousness. it gives a person's score between 3 (indicating deep unconsciousness) and 15 (indicating fully consciousness)
Time frame: change from preoperative Glascow Coma Scale score at the first 24 hours postoperatively
Intraoperative blood pressure.
Intraoperative haemodynamics (Systolic blood pressure in millimeter mercury, diastolic blood pressure in millimeter mercury. Mean arterial blood pressure in millimeter mercury.
Time frame: preoperatively, immediatly after intubation,after 5 minutes,afer 15 minutes,after 30 minutes,after 60 minutes,after 90 minutes and immediatly after extubation.
Intraoperative heart rate
Intraoperative heart rate per minute
Time frame: preoperatively, immediatly after intubation,after 5 minutes,afer 15 minutes,after 30 minutes,after 60 minutes,after 90 minutes and immediatly after extubation.
I.C.U admission
intensive care unit admission
Time frame: up to 28 days
I.C.U stay.
Length of stay in intensive care unit
Time frame: up to 28 days
Incidence of any complication.
Incidence of any complication (nausea, vomiting, convulsion and reopening).
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Time frame: up to 28 days