Ruptured Cerebral Aneurysm
Conditions
Brief summary
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.
Detailed description
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.
Interventions
Propofol (1.5-2 mg/kg/h) infusion, Midazolam (0.12 mg/kg/h) infusion
DRUGInhalation Anesthesia
Sevoflurane at a concentration of 2-2.5%
DRUGRescue fentanyl
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
Sponsors
Mansoura University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
20 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* American Society of Anesthesiologists physical status III or IV.
Exclusion criteria
* Morbid obese patients. * Severe or uncompensated cardiovascular diseases * Severe or decompensated renal diseases * Severe or decompensated hepatic diseases * Severe or decompensated endocrinal diseases. * Pregnancy * Postpartum * Lactating females * Allergy to one of the agents used. * Severely altered consciousness level. * Sitting or prone position during surgery.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Arterio-Jugular oxygen content difference | Immediately before and every 30 min for 6 hour following start of surgery | The differences between arterial and jugular bulb oxygen contents |
| Estimated cerebral metabolic rate for O2 (eCMRO2) | Immediately before and every 30 min for 6 hour following start of surgery | eCMRO2=Ca- jO2 x(PaCO2 ∕ 100), Where Ca jO2 is arterio-jugular O2 content difference. PaCO2 is arterial CO2 tension |
| Cerebral Extraction Rate of O2 (CEO2) | Immediately before and every 30 min for 6 hour following start of surgery | Calculated as the differences between arterial and jugular bulb O2 saturations, CEO2 = SaO2 - SjvO2 |
| Cerebral Blood Flow equivalent (CBFe) | Immediately before and every 30 min for 6 hour following start of surgery | : Which is an index of flow metabolism relationship, calculated as a reciprocal of arterio-jugular O2 content difference. CBFe = 1 ∕CaO2-CjvO. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| End tidal carbon dioxide tension | Immediately before and every 30 min for 6 hour following start of surgery | — |
| Sedation score | For 6 hours from induction of anesthesia | \- Postoperative level of sedation of all patients will be evaluated using Ramsay sedation scale |
| Heart rate | Immediately before and every 30 min for 6 hour following start of surgery | — |
| Duration of stay in intensive care unit | For 5 days after surgery | — |
| Time for first analgesic request from extubation | For 6 hours from induction of anesthesia | Time for first analgesic request from extubation |
| Mean arterial blood pressure | Immediately before and every 30 min for 6 hour following start of surgery | — |
| 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 | — |
Countries
Egypt
Outcome results
None listed