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Abstract
This is randomized controlled study was performed on ninety patients of either sex with age ranging between 15-65 years undergoing elective craniotomy for removal of brain tumour divided into 3 groups each of them 30 patients.
All patients were given 1 μg/kg IV fentanyl as premedication before induction of anesthesia, while induction of anesthesia was by 0.01 mg/kg atropine, sleeping dose of thiopentone, and 1 mg/kg suxamethonium to facilitate endotracheal intubation.
Muscle relaxation was maintained by 0.08 mg/kg pancronium followed by 1/5 of initial dose as incremental dose as needed.
The maintenance of anesthesia was conducted by 2 different techniques either inhalational by using isoflurane or Total Intravenous Anesthesia (TIVA) propofol-fentanyl and midazolam-fentanyl, to compare between two techniques for the best outcome of the patients, regarding hemodynamic stability, heart rate, and mean arterial blood pressure.
Jugular bulb catheter and arterial line for frequent sampling for continuous monitoring immediately at 5 and 30 minutes after induction of anesthesia and every hour after induction during craniotomy of Cerebral Blood Flow (CBF), Cerebral Metabolic Rate (CMRO2) Cerebral oxygen Extraction ratio (CEO2), and jugular bulb pressure.
Also 2 hours postoperatively, the sedation level of the patients were assessed by Ramsy sedation score.
The present study revealed the following:
There was good hemodynamic stability with subsequent stabilization of CBF and CMRO2 and highly significant increased CEO2 with propofol-fentanyl group, and good degree of sedation specially in the early 30 minute postoperative period with subsequent early recovery and comprehension.
Midazolam-fentanyl group showed less stability in hemodynamics with marked increase in jugular bulb oxygen saturation and decreased cerebral extraction of oxygen, also showed heavy sedation in the postoperative period which may be adverse effect of this group.