Comparative Study of Haemodynamic Effects and ICP Changes of Remifentanil & Propofol Using "TIVA" with Conventional N 2O O2/lsoflurane in Brain Surgery

Abstract

Sixty adults gave written informed consent for this prospective randomized trial. Patients were scheduled to perform excision of supratentorial space occupying tumor. In group I (remifentanil or TIVA group), anesthesia was induced with propofol 2 mg/kg, remifentanil 1 J.tg/kg and maintained by infusion of both drugs propofol 4 mg/kg/min. and remifentanil 0.5 J.tg/kg/min. In group II (fentanyl group or inhalational group), anesthesia was induced by . thiopental 5 mg/kg, fentanyl 3 J.tg/kg/then anesthesia was maintained by isoflurane 1% and N20 50% in oxygen. Intubation was facilitated in both groups by 0.1 mg vecuronium. Doses were adjusted to maintain anesthesia and stable hemodynamics. Hemodynamics (MAP and HR) and ICP were monitored. In the early postoperative period, hemodynamics and time to recovery were monitored for 30 minutes. . Analgesic requirements and nausea and vomiting were observed. Results: Induction hemodynamics were similar. MAP and HR were greater in patients receiving fentanyl during surgical stimulus, hemodynamic stability was more significant in remifentanil group than in fentanyl group throughout the surgery. ICP and brain relaxation were rated as better for surgical procedure in both groups, with little significant reduction in group I was seen. Postoperative MAP and HR were greater in remifentanil group and analgesics were required earlier in group I. Recovery as regard, time to adequate respiration time to extubation and time to follow-verbal commands was better in group I. Conclusion: Remifentanil appears to be a reasonable alternative to fentanyl during elective supratentorial craniotomy.