Brain Tumor Adult
Conditions
Brief summary
Intraoperative flash visual evoked potentials (FVEPs) could monitor visual function during neurosurgery. There are fewer reports comparing the effects of sevoflurane-propofol balanced anesthesia and propofol-based total intravenous anesthesia under comparable bispectral index (BIS) levels on the amplitude and latency of flash visual evoked potentials (FVEPs) for sellar or parasellar tumors resection neurosurgeries.
Detailed description
The overall incidence rate of sellar tumors is 10-20% of brain tumors. Most of the initial symptoms of this tumor are visual or visual impairment. One of the primary complications of these operations is visual impairment, which directly relates to the quality of patients' life. Flash visual evoked potentials (FVEPs) is an important means of intraoperative visual function evaluation under general anesthesia. Intraoperative visual function damage can be avoided or reduced by observing the changing of FVEPs waves to guide the choice of surgical path. However, since the diversity of anesthetic drugs and methods, there is still a great uncertainty impact on FVEPs, which will interfere with the interpretation and judgment of surgeons and neuroelectrophysiological physicians respect to the changes of FVEPs amplitude and latency, and further affect the operation decision-making. Therefore, it is urgent to establish a perfect anesthesia method for intraoperative monitoring of FVEPs. Although total intravenous anesthesia has been widely accepted for FVEPs monitoring, there are still some limitations, such as the possibility of intraoperative body movement and cough due to the restriction of muscle relaxant use under electrophysiological monitoring, as well as the depression on FVEPs of high maintained dosage under total intravenous anesthesia. The purpose of this study was to investigate the feasibility of FVEPs monitoring during endoscopic sellar tumor resection under combined intravenous anesthesia compared with total intravenous anesthesia.
Interventions
DRUGPropofol
Propofol will be administered for anesthesia maintenance in patients randomized to the propofol-based TIVA arm of the study. In order to record the VEPs, standard spiral electrodes or subcutaneous electrodes will be inserted subcutaneously around the visual area and the Nicolet Viking IV System will be used to monitor VEP during surgery.
DRUGSevoflurane
Balanced general anesthesia with sevoflurane will be administered for anesthesia maintenance in patients randomized to the balanced general anesthesia arm of the study. In order to record the VEPs, standard spiral electrodes or subcutaneous electrodes will be inserted subcutaneously around the visual area and the Nicolet Viking IV System will be used to monitor VEP during surgery.
Sponsors
Beijing Tiantan Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
1. Age 18-65 years; 2. ASA I-III; 3. Elective sellar or parasellar tumors resection; 4. Informed written consent
Exclusion criteria
1. Preoperative visual acuity\<0.3; 2. BMI\>30kg/cm2; 3. Uncontrolled hypertension, diabetes or cardiac diseases; 4. Preoperative cognitive disorders; 5. Sedatives, alcohol or analgesic addiction history; 6. Allergy to drugs of this study or contact allergy to Silicone products
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| N2 amplitudes of FVEPs | 90min after anesthesia induction | N145-P100 of FVEPs wave |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| P100 latencies of FVEPs | 30, 60 and 90min after anesthesia induction | P100 latencies of FVEPs wave |
| The visual acuity | The day before surgery, and one day after operation. | The visual acuity before and after operation. |
| The visual field | The day before surgery, and one day after operation. | The field of patients before and after operation. |
| N2 amplitudes of FVEPs | 30 and 60 after anesthesia induction | N145-P100 of FVEPs wave |
Countries
China
Contacts
Primary ContactRuquan Han, M.D., Ph. D
Outcome results
None listed