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| |  Controlling Early Emergence Among Craniotomy Patients: Presented at ASA By Arushi Sinha, PhD SAN FRANCISO, CA -- October 22, 2007 -- For patients undergoing craniotomy, rapid awakening from anaesthesia can be key to the early detection of potential cerebral complications. Hypertension may be a complicating risk factor for intracranial haematomas, and therefore, its incidence should be limited. A study presented here at the Annual Meeting of the American Society of Anesthesiologists (ASA) examined the use of low-dose anaesthetics, such as propofol, fentanyl, or isoflurane, to improve outcomes. "There are advantages for early emergence in neurological patients," said Hemant Bhagat, MD, Senior Research Associate, Department of Neuroanaesthesiology, CN Centre, All India Institute of Medical Sciences, New Delhi, India. Dr. Bhagat and colleagues enrolled 150 patients with supratentorial tumours treated with standard isoflurane anaesthesia. From the beginning of dural closure to 1 hour postextubation, patients were randomised to receive low-dose propofol (n = 50; 3 mg/kg/hr), fentanyl (n = 50; 1.5 mcg/kg/hr), or isoflurane (n = 50; 0.2% end-tidal concentration). The low-dose anaesthetics were administered only until the beginning of skin closure. Nitrous oxide dosing was discontinued upon initiating the dressing of the surgical wound. Median time to emergence from anaesthesia was found to be 6 minutes in the propofol group, 4 minutes for the fentanyl group, and 2 minutes for the isoflurane group (P =.008). There were statistically significant differences in hypertension rates between patients receiving isoflurane and fentanyl patients during the extubation period (P =.005) as well as overall period of emergence (P =.003). Among the critical time periods during surgery, more patients experienced hypertension in the pre-extubation stage than during either extubation or postextubation stages (P =.009). The researchers also compiled the overall incidence of hypertension among all patients. In addition, the researchers noted that fewer patients required esmolol with fentanyl use (P =.01). "This is the first-of-its-kind study among neurosurgical patients," explained Dr. Bhagat. Based on these results, the researchers concluded that all three agents were similar in allowing for early emergence from the effects of anaesthetics among craniotomy patients. They further observed that low-dose fentanyl may have some benefits when compared with isoflurane. "This study shows that fentanyl has advantages over isoflurane on limiting the incidence of hypertension," summarised Dr. Bhagat.
[Presentation title: Planning for Early Emergence in Neurosurgical Patients: A Comparison of Low Dose Anesthetics. Abstract A1079]
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