期刊
EUROPEAN JOURNAL OF TRAUMA AND EMERGENCY SURGERY
卷 47, 期 3, 页码 831-837出版社
SPRINGER HEIDELBERG
DOI: 10.1007/s00068-019-01249-4
关键词
TIVA; Inhalational agents; Traumatic brain injury; ICP
In patients with severe traumatic brain injury, total intravenous (Propofol)-based anesthesia provides better brain relaxation, maintains lower ICP, and better hemodynamics compared to inhalational anesthesia.
Background The major goals of anesthesia in patients with severe traumatic brain injury (TBI) are-maintenance of hemodynamic stability, optimal cerebral perfusion pressure, lowering of ICP, and providing a relaxed brain. Although both inhalational and intravenous anesthetics are commonly employed, there is no clear consensus on which technique is better for the anesthetic management of severe TBI. Methods Ninety patients, 18-60 years of age, of either gender, with GCS < 8, posted for emergency evacuation of acute subdural hematoma were enrolled in this prospective trial, and they were randomized into two groups of 45 each. Patients in group P received propofol infusion at 100-150 mg/kg/min for maintenance of anesthesia and those in group I received <= 1 MAC of isoflurane. Hemodynamic parameters were monitored in all patients. ICP was measured at the dural opening and brain relaxation was assessed by the operating surgeon on a four-point scale (1-perfectly relaxed, 2-satisfactorily relaxed, 3-firm brain, and 4-bulging brain) at the dural opening. It was reassessed at dural closure. Results Brain relaxation, both at dural opening and closure, was significantly better in patients who received propofol compared to those who received isoflurane. ICP was significantly lower (25.47 +/- 3.72 mmHg vs. 23.41 +/- 3.97 mmHg) in the TIVA group. Hemodynamic parameters were well maintained in both groups. Conclusions In patients with severe TBI, total intravenous (Propofol)-based anesthesia provided better brain relaxation, maintained a lower ICP along with better hemodynamics when compared to inhalational anesthesia.
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