Chui Jason, Mariappan Ramamani, Mehta Jigesh, Manninen Pirjo, Venkatraghavan Lashmi
Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
Can J Anaesth. 2014 Apr;61(4):347-56. doi: 10.1007/s12630-014-0118-9. Epub 2014 Jan 31.
Both propofol and volatile anesthetics are commonly used for maintenance of anesthesia in patients undergoing neurosurgical procedures. The effects of these two classes of drugs on cerebral hemodynamics have been compared in many clinical trials The objectives of this review were to evaluate the cerebral hemodynamic effects, operative conditions, recovery profiles, postoperative complications, and neurological outcomes of propofol-based vs volatile-based anesthesia for craniotomy.
MEDLINE®, EMBASE™, Cochrane, and other relevant databases were searched for randomized controlled trials that compared propofol-maintained anesthesia with volatile-maintained anesthesia in adult patients undergoing elective craniotomy. The primary outcome measure was the intraoperative brain relaxation score. Secondary outcome measures included intraoperative cerebral hemodynamics (intracranial pressure [ICP], cerebral perfusion pressure [CPP]), cardiovascular changes, recovery profiles, postoperative complications, and clinical outcomes (neurological morbidity, mortality, quality of life). A meta-analysis was conducted using a random effects model to compare the outcomes of the two anesthetic techniques.
Fourteen studies (1,819 patients) met inclusion criteria and were analyzed. Brain relaxation scores were similar between the two groups after dural opening; however, ICP was lower (weighted mean difference of -5.2 mmHg; 95% confidence interval -6.81 to -3.6) and CPP was higher (weighted mean difference of 16.3 mmHg; 95% confidence interval 12.2 to 20.46) in patients receiving propofol-maintained anesthesia. Postoperative complications and recovery profiles were similar between the two groups, except for postoperative nausea and vomiting being less frequent with propofol-maintained anesthesia. There were inadequate data to perform a meta-analysis on clinical outcome.
Propofol-maintained and volatile-maintained anesthesia were associated with similar brain relaxation scores, although mean ICP values were lower and CPP values higher with propofol-maintained anesthesia. There are inadequate data to compare clinically significant outcomes such as neurological morbidity or mortality.
丙泊酚和挥发性麻醉剂常用于神经外科手术患者的麻醉维持。在许多临床试验中已对这两类药物对脑血流动力学的影响进行了比较。本综述的目的是评估基于丙泊酚的麻醉与基于挥发性麻醉剂的麻醉用于开颅手术时的脑血流动力学效应、手术条件、恢复情况、术后并发症及神经学转归。
检索MEDLINE®、EMBASE™、Cochrane及其他相关数据库，查找在接受择期开颅手术的成年患者中比较丙泊酚维持麻醉与挥发性麻醉剂维持麻醉的随机对照试验。主要结局指标为术中脑松弛评分。次要结局指标包括术中脑血流动力学（颅内压[ICP]、脑灌注压[CPP]）、心血管变化、恢复情况、术后并发症及临床结局（神经疾病、死亡率、生活质量）。采用随机效应模型进行荟萃分析以比较两种麻醉技术的结局。
14项研究（1819例患者）符合纳入标准并进行分析。硬脑膜切开后两组脑松弛评分相似；然而，接受丙泊酚维持麻醉的患者ICP较低（加权平均差为-5.2 mmHg；95%置信区间-6.81至-3.6）且CPP较高（加权平均差为16.3 mmHg；95%置信区间12.2至20.46）。两组术后并发症及恢复情况相似，丙泊酚维持麻醉组术后恶心和呕吐发生率较低除外。缺乏进行临床结局荟萃分析的数据。
丙泊酚维持麻醉和挥发性麻醉剂维持麻醉的脑松弛评分相似，尽管丙泊酚维持麻醉时平均ICP值较低且CPP值较高。缺乏比较神经疾病或死亡率等临床显著结局的数据。
