Document Detail

Total intravenous anesthesia: advantages for intracranial surgery.
MedLine Citation:
PMID:  18091252     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Although volatile anesthetics have been widely accepted in anesthetic management for neurosurgery, they reduce vascular resistance, resulting in increased cerebral blood flow and increased intracranial pressure (ICP). In patients with elevated ICP who undergo craniotomy, the increase in ICP during surgery from inhaled anesthetics can make the surgery more difficult, thereby increasing the risk of ischemic cerebral insults. Total intravenous anesthesia (TIVA) using propofol and analgesic drugs (remifentanil or fentanyl) and excluding simultaneous administration of any inhaled drugs is being used in patients undergoing craniotomy because of its potential to reduce ICP and ease access to the operative site. METHODS: We reviewed the literature and describe our experience with TIVA, with emphasis on hemodynamic stability, effects on ICP, emergence from anesthesia, extubation times, and return of cognitive function in patients undergoing craniotomy for space-occupying lesions. RESULTS: TIVA with propofol is similar to inhaled anesthetics with regard to hemodynamic stability, emergence times, extubation times, early cognitive function, and adverse events. In several prospective, randomized clinical trials, evidence suggests that ICP is decreased and cerebral perfusion pressure is increased in patients receiving TIVA when compared with those receiving volatile anesthetics during elective craniotomy procedures. CONCLUSION: The impact of TIVA on ICP, brain swelling, and access to the operative site in patients with severely elevated ICP has yet to be evaluated and is the subject of a future study at our institution.
Chad D Cole; Oren N Gottfried; Dhanesh K Gupta; William T Couldwell
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Neurosurgery     Volume:  61     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-12-19     Completed Date:  2008-02-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  369-77; discussion 377-8     Citation Subset:  IM    
Department of Neurosurgery, University of Utah, Salt Lake City, Utah 84132, USA.
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MeSH Terms
Anesthesia, Intravenous / methods*
Brain Diseases / surgery*
Craniotomy / methods*
Neurosurgical Procedures*

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