Three balanced anesthetic techniques for neuroanesthesia: infusion of thiopental sodium with sufentanil or fentanyl compared with inhalation of isoflurane
- PMID: 1389190
- DOI: 10.1016/0952-8180(92)90158-w
Three balanced anesthetic techniques for neuroanesthesia: infusion of thiopental sodium with sufentanil or fentanyl compared with inhalation of isoflurane
Abstract
Study objective: To compare emergence from anesthesia and the hemodynamic and respiratory depressant effects of thiopental sodium infusion plus sufentanil or fentanyl with those of isoflurane as the primary component of a balanced technique for neuroanesthesia.
Design: Randomized, double-blind, prospective study.
Setting: University hospital and its affiliated Veterans Affairs Medical Center.
Patients: Thirty patients undergoing elective craniotomy for aneurysm or tumor.
Interventions: Thiopental with infusion of sufentanil 0.1 microgram/kg/hr, thiopental with infusion of fentanyl 1 microgram/kg/hr, or inhalation of 0.25% to 2% isoflurane as the major component of a balanced anesthesia technique that included nitrous oxide (N2O) and vecuronium (potency ratio of sufentanil to fentanyl, 10:1).
Measurements and main results: Intraoperative stress response (as indicated by intraoperative hypertension) was said to be the percentage of time the patient required administration of an antihypertensive drug, measuring from the first dose of thiopental to discontinuation of N2O at the end of the procedure, excluding any period of induced hypotension. Rapidity of emergence was measured by the number of minutes from discontinuation of N2O to first opening of the eyes on command. Adequacy of spontaneous ventilation was evaluated by determining partial pressure of arterial carbon dioxide 1, 2, and 3 hours after discontinuation of N2O. Extent of vasoactive drug administration for control of intraoperative hypertension (as determined by the clinicians caring for the patients) was described by minutes of vasodilator infusion and milligrams of propranolol or labetalol administered. The frequency of postoperative hypertension was defined as the number of patients in each group who required medication for postoperative hypertension. No significant differences in variables were found for thiopental/sufentanil, thiopental/fentanyl, or isoflurane when these drugs were used with N2O and vecuronium.
Conclusions: Any one of these balanced anesthetic techniques appears appropriate for craniotomy.
Similar articles
-
A prospective, comparative trial of three anesthetics for elective supratentorial craniotomy. Propofol/fentanyl, isoflurane/nitrous oxide, and fentanyl/nitrous oxide.Anesthesiology. 1993 Jun;78(6):1005-20. doi: 10.1097/00000542-199306000-00002. Anesthesiology. 1993. PMID: 8512094 Clinical Trial.
-
Anesthesia for craniotomy: total intravenous anesthesia with propofol and alfentanil compared to anesthesia with thiopental sodium, isoflurane, fentanyl, and nitrous oxide.J Clin Anesth. 1991 Mar-Apr;3(2):131-6. doi: 10.1016/0952-8180(91)90010-k. J Clin Anesth. 1991. PMID: 2039640 Clinical Trial.
-
Continuous opioid infusions for neurosurgical procedures: a double-blind comparison of alfentanil and fentanyl.Can J Anaesth. 1991 Sep;38(6):710-6. doi: 10.1007/BF03008447. Can J Anaesth. 1991. PMID: 1914054 Clinical Trial.
-
Anesthetic management of obstructive sleep apnea patients.J Clin Anesth. 1991 Nov-Dec;3(6):461-9. doi: 10.1016/0952-8180(91)90094-4. J Clin Anesth. 1991. PMID: 1760169 Review.
-
Clinical use of sufentanil as an anesthetic.J Pain Symptom Manage. 1992 Aug;7(6):362-4. doi: 10.1016/0885-3924(92)90090-5. J Pain Symptom Manage. 1992. PMID: 1387674 Review.
Cited by
-
Opioid-Sparing Effects of Flurbiprofen Axetil as an Adjuvant to Ropivacaine in Pre-Emptive Scalp Infiltration for Post-Craniotomy Pain: Study Protocol for a Multicenter, Randomized Controlled Trial.J Pain Res. 2023 Apr 26;16:1415-1427. doi: 10.2147/JPR.S399454. eCollection 2023. J Pain Res. 2023. PMID: 37131532 Free PMC article.
-
Intravenous versus inhalational techniques for rapid emergence from anaesthesia in patients undergoing brain tumour surgery.Cochrane Database Syst Rev. 2016 Sep 9;9(9):CD010467. doi: 10.1002/14651858.CD010467.pub2. Cochrane Database Syst Rev. 2016. PMID: 27611234 Free PMC article. Review.
-
Gender rather than choice of intermediate duration opioids affects emergence after craniotomy for large intracranial tumors.Ochsner J. 2011 Spring;11(1):22-8. Ochsner J. 2011. PMID: 21603331 Free PMC article.
-
Subdural pressure and brain condition during propofol vs isoflurane - nitrous oxide anaesthesia in patients undergoing elective supratentorial tumour surgery.Indian J Anaesth. 2009 Feb;53(1):44-51. Indian J Anaesth. 2009. PMID: 20640077 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources