Surgery Clinical Trial
Official title:
Effect of Propofol-Dexmedetomidine Total Intravenous Anaesthesia on Cerebral Oxygenation and Metabolism During Brain Tumor Resection Compared to Sevoflurane Anaesthesia
Despite theoretical benefits of intravenous agents, volatile agents remain popular. In a
study comparing desflurane, isoflurane, and sevoflurane in a porcine model of intracranial
hypertension, at equipotent doses and normocapnia, cerebral blood flow (CBF) and
intra-cranial pressure (ICP) were least with sevoflurane.
Propofol is the most commonly used intravenous anesthetic. It has many theoretical advantages
by reducing cerebral blood volume (CBV) and ICP and preserving both autoregulation and
vascular reactivity. Neurosurgical patients anaesthetized with propofol were found to have
lower ICP and higher CPP than those anaesthetized with isoflurane or sevoflurane.
The well known pharmacodynamic advantages of intravenous anesthetics may give this group of
drugs superior cerebral effects when compared with inhalation anesthetics.
The aim of this study is to evaluate the cerebral haemodaynamics and global cerebral
oxygenation as well as the systemic haemodaynamic changes using dexmedetomidine, propofol and
fentanyl as total intravenous anaesthestics (TIVA) in comparison with sevoflurane - fentanyl
anesthesia in brain tumor resection.
Indicators of global cerebral oxygenation and haemodynamics will be calculated using jugular
bulb and peripheral arterial blood sampling.
- Induction: propofol, 1.5 - 2 mg/kg.
- Muscle Relaxants: atracurium, 0.5 mg/kg with induction and 0.1 mg/kg/20min. for
maintenance.
- Cannulation: Arterial cannula: under complete aseptic conditions 20G cannula was
inserted into the radial artery of non dominant hand after performing modified Allen`s
test and local infiltration of 0.5ml xylocaine 2%.
Central venous catheter: A suitable central venous catheter will be inserted into Rt
subclavian vein under complete aseptic technique, its correct position will be confirmed with
chest X-Ray.
Jugular bulb catheterization: Under strict sterile technique the right internal jugular vein
will be cannulated in a retrograde technique with confirmation of the catheter tip position
using X-Ray (C- arm). Puncture site will be at the level of cricoid cartilage behind the
anterior border of the sternocleido-mastoid muscle.
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