Supratentorial Tumor
Conditions
Brief summary
Optional brain relaxation improves the surgeon's operating conditions and is likely to minimize the degree of retraction injury ,with the potential for providing patients with a better outcome. The choice of anesthetic drugs can affect intraoperative brain relaxation. Propofol suppresses brain metabolism, reduces cerebral blood flow, and provides satisfactory brain relaxation. Desflurane is often criticized in neurosurgery due to its cerebral vasodilation and potential to increase intracranial pressure, however, it has been found to have a little clinical significance. This study intends to compare the effects of desflurane with propofol on brain relaxation in patients with supratentorial tumors under mild hyperventilation, and to provide new clinical evidence for the use of desflurane in neurosurgical anesthesia.
Detailed description
To compare the effect of desflurane versus propofol combined with remifentanil anesthesia on brain relaxation in patients undergoing supratentorial tumor surgery with mild hyperventilation, and compare the emergence time and common complications during recovery.
Interventions
DRUGDesflurane
After induction, anesthesia will be maintained with 0.8-1.3 MAC desflurane and 0.05-0.2 μg/kg/min remifentanil.
DRUGPropofol
After induction, anesthesia will be maintained with 6-8 mg/kg/h propofol and 0.05- 0.2 μg/kg/min remifentanil
Sponsors
Beijing Tiantan Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* 18-60 years * Scheduled for elective craniotomy for supratentorial cerebral tumors * ASA status I-III * Glasgow score of 15 * No clinical signs of intracranial hypertension * Preoperative brain imaging (CT or MRI) with midline shift less than 5mm * Informed consent signed by patients
Exclusion criteria
* Scheduled intraoperative motor evoked potential monitoring * Patients with cerebral vascular diseases * Uncontrolled cardiopulmonary disease * Schedule to retain tracheal intubation after surgery * Unable to comprehend and cooperate with the examination * BMI \> 30 Kg/m-2 * Emergency surgery * History of related anesthetic allergy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of satisfactory brain relaxation | during surgery | Assessed by the neurosurgeon using a 4-point scale (1= perfectly relaxed, 2= satisfactorily relaxed, 3= firm brain, 4=bulging brain) at the opening of the dura mater, score 1 and 2 represent satisfactory brain relaxation |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Dural tension | during surgery | evaluated using a 4-point scale after bone flap removal. |
| Quality of anesthesia recovery | at postoperative day 1 | assessed by quality of recovery-15 scale (QoR-15) |
| Emergence time | from drug discontinuation to eye opening, assessed up to 1 hours | from drug discontinuation to eye opening |
| Extubation time | from drug discontinuation to tracheal extubation, assessed up to 1 hours | from drug discontinuation to tracheal extubation |
| Early postanesthesia cognitive recovery | at 15, 30min after tracheal extubation | evaluated by Short Orientation Memory Concentration Test (SOMCT) |
| Postoperative pain and postoperative nausea and vomiting (PONV) | during the PACU stay and postoperative day 1. | evaluated by Visual Analogue Score(VAS). |
| Duration in PACU (Postanesthesia care unit) | from entering PACU to exiting PACU, an expected average of 1 hour | time from entering PACU to exiting PACU |
| Anesthesia expenses | at postoperative day 1 | Total cost of anesthesia |
| Postoperative complications | from drug discontinuation to discharge from PACU (Postanesthesia care unit), assessed up to 3 hours | incidence of hypoxemia, hypotension, hypertension, tachycardia, bradycardia, agitation, shivering. |
Countries
China
Outcome results
None listed