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No Difference in Emergence Time and Early Cognitive Function Between Sevoflurane-Fentanyl and Propofol-Remifentanil in Patients Undergoing Craniotomy for Supratentorial Intracranial Surgery

Magni, G MD, PhD; Baisi, F MD; Rosa, I La MD; Imperiale, C MD; Fabbrini, V MD; Pennacchiotti, M L MD; Rosa, G MD

Journal of Neurosurgical Anesthesiology: July 2005 - Volume 17 - Issue 3 - p 134-138
doi: 10.1097/01.ana.0000167447.33969.16
Clinical Investigation

Balanced anesthesia with sevoflurane-fentanyl has been widely accepted as anesthetic management for neurosurgery. Propofol-remifentanil regimen has been successfully used in various surgical settings, but a comprehensive comparison of sevoflurane-fentanyl and propofol-remifentanil anesthesia in patients undergoing craniotomy for supratentorial intracranial surgery has not yet been done. The aim of this prospective, randomized, open-label clinical trial was to compare clinical properties of sevoflurane-fentanyl with propofol-remifentanil anesthesia in patients undergoing supratentorial intracranial surgery. The primary endpoint was to compare early postoperative recovery and cognitive functions within the two groups; we also evaluated hemodynamic events, vomiting, shivering, and pain. One hundred twenty patients (64 males; age 15-75 years) were randomized to either total intravenous anesthesia (group T) or sevoflurane anesthesia (group S). Emergence and extubation times and cognitive function (Short Orientation Memory Concentration Test [SOMCT]) were compared in the two groups. Brain swelling, incidence of hypotensive and hypertensive episodes, postoperative vomiting, shivering, and pain were also analyzed. The mean emergence time (12.2 ± 4.9 minutes for group S versus 12.3 ± 6.1 minutes for group T; P = 0.92) and extubation time (18.2 ± 2.3 minutes for group S versus 18.3 ± 2.1 minutes for group T; P = 0.80) were similar in the two groups. Average SOMCT scores, both 15 minutes after extubation (25.6 ± 4.9 in group S versus 23.9 ± 7.5 in group T; P = 0.14) and 45 minutes after extubation (27.3 ± 2.2 in group S versus 26.0 ± 5.1 in group T; P = 0.07) were also comparable. Brain swelling was present in seven and five patients in groups S and T, respectively (P = 0.76). Hypotension was present in 12% (group S) and 28% (group T) of patients (P = 0.02). Hypertension was present in 17% of patients in group S and 40% of patients in group T (P = 0.0046). Shivering was present in 18% and 25% of patients in groups T and S (P = 0.37). Our study demonstrates that there is no patient benefit of using total intravenous anesthesia with an ultra-short-acting opioid over the conventional balanced volatile technique in terms of recovery and cognitive functions.

From the Department of Anesthesia and Intensive Care, Policlinico Umberto I, University of Rome “La Sapienza,” Rome, Italy.

Received for publication November 1, 2004; accepted April 14, 2005.

Drs. Magni and Baisi contributed equally to this manuscript.

Reprints: Dr. G. Magni, Department of Anesthesia and Intensive Care, Policlinico Umberto I, Viale del Policlinico, 155-00100 Roma, Italy (e-mail:

© 2005 Lippincott Williams & Wilkins, Inc.