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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Total intravenous anesthesia (TIVA) | Experimental | Patients will receive total intravenous anesthesia using Propofol and Midazolam |
|
| Inhalation Anesthesia | Active Comparator | Patients will receive Inhalation anesthesia using Sevoflurane |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Total intravenous anesthesia (TIVA) | Drug | Propofol (1.5-2 mg/kg/h) infusion, Midazolam (0.12 mg/kg/h) infusion |
|
| Measure | Description | Time Frame |
|---|---|---|
| Arterio-Jugular oxygen content difference | The differences between arterial and jugular bulb oxygen contents | 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 | 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 | 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. | Immediately before and every 30 min for 6 hour following start of surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Heart rate | Immediately before and every 30 min for 6 hour following start of surgery | |
| Mean arterial blood pressure | Immediately before and every 30 min for 6 hour following start of surgery | |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Sherif A Mousa, MD | Professor | Study Chair |
| Mohammed A Ghanem, MD | Associate Professor | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Sherif A Mousa | Al Mansurah | DK | 050 | Egypt |
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| ID | Term |
|---|---|
| D000769 | Anesthesia, Inhalation |
| ID | Term |
|---|---|
| D000768 | Anesthesia, General |
| D000758 | Anesthesia |
| D000760 | Anesthesia and Analgesia |
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| Inhalation Anesthesia | Drug | Sevoflurane at a concentration of 2-2.5% |
|
| Rescue fentanyl | Drug | 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 |
|
| Peripheral oxygen saturation |
| Immediately before and every 30 min for 6 hour following start of surgery |
| Central venous pressure | Immediately before and every 30 min for 6 hour following start of surgery |
| End tidal carbon dioxide tension | 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 | For 6 hours from induction of anesthesia |
| Time for first analgesic request from extubation | Time for first analgesic request from extubation | For 6 hours from induction of anesthesia |
| Duration of stay in intensive care unit | For 5 days after surgery |