The comparative effects of desflurane and isoflurane on lumbar cerebrospinal fluid pressure in patients undergoing craniotomy for supratentorial tumors.

Abstract

UNLABELLED:

We compared the effects of desflurane and isoflurane on cerebral perfusion pressure (CPP), lumbar cerebrospinal fluid pressure (LCSFP), and mean arterial blood pressure (MAP) in patients anesthetized with desflurane or isoflurane undergoing craniotomy for supratentorial mass lesions. Additionally, emergence from anesthesia was examined to determine if neurologic function could be assessed earlier after isoflurane or desflurane anesthesia. Thirty-six patients were randomized to receive either desflurane or isoflurane for maintenance of anesthesia at 1.2 minimum alveolar concentration (MAC). Patients were hyperventilated (PaCO(2), 30 +/- 2 mm Hg) after baseline LCSFP was obtained via the subarachnoid catheter. At a MAC of 1.2, mean LCSFP was not statistically different between the two study groups either before or after hyperventilation. Additionally, CPP was not significantly different between the two groups. Finally, patient's time to respond to commands was 50% shorter in the desflurane group (30 +/- 36 min) (mean +/- SD) when compared with the isoflurane group (72 +/- 126 min); however, this was not significant (P = 0.17). In patients undergoing craniotomy for supratentorial mass lesions, desflurane and isoflurane have similar effects on CPP and MAP. Additionally, desflurane in the setting of hyperventilation does not cause significant changes in LCSFP.

IMPLICATIONS:

This is the largest study to date comparing the effects of desflurane and isoflurane on patients undergoing craniotomy for supratentorial mass lesion with evidence of midline shift or edema. Neither desflurane nor isoflurane significantly altered lumbar cerebrospinal fluid pressure when moderate hypocapnia was maintained.

• Authors: Alan Kaye, Ian J Kucera, James Heavner, Adrian Gelb, Muhamed Anwar, Marilyn Duban, A Salam Arif, Rosemary Craen, Cheng-Tao Chang, Raul Trillo, Marc Hoffman
• Journal: Anesthesia and analgesia (Anesth Analg) Vol. 98 Issue 4 Pg. 1127-1132 (Apr 2004) ISSN: 0003-2999 [Print] United States
• PMID: 15041612 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Anesthetics, Inhalation
• Desflurane
• Isoflurane

Topics

• Aged
• Anesthesia Recovery Period
• Anesthetics, Inhalation
• Blood Pressure (drug effects)
• Cerebrospinal Fluid Pressure (drug effects)
• Cerebrovascular Circulation (drug effects)
• Craniotomy
• Desflurane
• Female
• Humans
• Intracranial Pressure (drug effects)
• Isoflurane (analogs & derivatives)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Neurosurgical Procedures
• Supratentorial Neoplasms (complications, physiopathology, surgery)