Intarakhao Patcharin, Thiarawat Peeraphong, Dhippayom Teerapon
Department of Anaesthesiology, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand.
Department of Neurosurgery, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand.
Indian J Anaesth. 2025 Aug;69(8):770-778. doi: 10.4103/ija.ija_189_25. Epub 2025 Jul 10.
The impact of anaesthetic agents on brain relaxation during neurosurgical procedures remains debatable. This study aimed to compare propofol and volatile anaesthetics during maintenance anaesthesia in achieving optimal brain relaxation in adults undergoing intracranial surgery.
We searched PubMed, Embase, Cochrane, and EBSCO Open Dissertations databases from inception to February 2024. Randomised controlled trials (RCTs) comparing anaesthetic agents in patients over 18 years old undergoing neurosurgical procedures were included. The primary outcome was the proportion of subjects who achieved satisfactory brain relaxation, as indicated by a score of 1 on the 4-point Brain Relaxation Score (BRS). The revised Cochrane risk of bias tool was used to evaluate the quality of included studies. Risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effects model. The effects on brain relaxation were ranked using the surface under the cumulative ranking (SUCRA). We also evaluated the certainty of evidence using the Confidence in Network Meta-Analysis (CINeMA) online platform.
Out of 2,264 articles identified, 11 RCTs involving 1,367 participants were included. The chance of having satisfactory brain relaxation of the following anaesthetics appeared to be lower than propofol: sevoflurane (RR: 0.93; 95% CI: 0.79, 1.09), isoflurane (RR: 0.89; 95% CI: 0.60, 1.34), and desflurane (RR: 0.83; 95% CI: 0.65, 1.07), with moderate certainty of evidence. Propofol had the highest SUCRA ranking (81.4%).
Although all anaesthetic agents had similar effects, propofol showed a tendency towards better brain relaxation during neurosurgery. Further robust evidence is required to confirm the potential advantages of propofol.
麻醉药物对神经外科手术期间脑松弛的影响仍存在争议。本研究旨在比较丙泊酚和挥发性麻醉药在维持麻醉期间对接受颅内手术的成年人实现最佳脑松弛的效果。
我们检索了从数据库建立至2024年2月的PubMed、Embase、Cochrane和EBSCO开放学位论文数据库。纳入比较18岁以上接受神经外科手术患者使用不同麻醉药物的随机对照试验（RCT）。主要结局是在4分制脑松弛评分（BRS）中得分为1分，即达到满意脑松弛的受试者比例。采用修订的Cochrane偏倚风险工具评估纳入研究的质量。使用随机效应模型计算风险比（RR）和95%置信区间（CI）。使用累积排序曲线下面积（SUCRA）对脑松弛效果进行排序。我们还使用网络Meta分析可信度（CINeMA）在线平台评估证据的确定性。
在识别出的数据中，2264篇文章中，11项RCT共纳入1367名参与者。以下麻醉药实现满意脑松弛的可能性似乎低于丙泊酚：七氟烷（RR：0.93；95%CI：0.79，1.09）、异氟烷（RR：0.89；95%CI：0.60，1.34）和地氟烷（RR：0.83；95%CI：0.65，1.07），证据确定性为中等。丙泊酚的SUCRA排名最高（81.4%）。
尽管所有麻醉药物的效果相似，但丙泊酚在神经外科手术期间显示出更好的脑松弛趋势。需要进一步有力的证据来证实丙泊酚的潜在优势。
