Comparison of Cerebral Blood Flow During Recovery Between Total Intravenous Anesthesia Versus Balanced Anesthesia Technique in Patients Undergoing Elective Supratentorial Craniotomy: A Randomized Controlled Trial

Craniotomies have a higher rate of postoperative complications than the general surgical population and adversely affect the quality of life. Moreover, patients undergoing craniotomy develop postoperative cognitive and physical deficits which makes it difficult to assess the postoperative quality of recovery. With the advances in imaging and surgical techniques, the focus has shifted from merely eliminating pathology to ensuring maximal functional recovery as early as possible. Hence, it is important that anaesthetic techniques in addition to providing favorable intraoperative hemodynamics and brain relaxation must ensure a good quality of recovery to the patient as perceived by the patient.

It has been hypothesized that different anaesthetic strategies have differential effects on cerebral blood flow (CBF) and metabolic demand (CMRO2). Both propofol and volatile agents reduce CMRO2, and propofol and volatile agents are both systemic vasodilators, although propofol has been shown to reduce CBF, while volatile agents increase CBF. Also, volatile agents impair cerebral autoregulation in a dose-dependent manner, whereas propofol does so to a lesser extent. It is plausible that these divergent cerebrovascular properties have differing effects on the CBF and may impact outcomes in patients undergoing supratentorial craniotomies. We aimed to evaluate the effect of anaesthesia, which is either TIVA with propofol or balanced anaesthesia with Sevoflurane on cerebral blood flow by transcranial doppler (TCD) measurement of Mean Flow Velocity (MFV) of the middle cerebral artery (MCA) in patients undergoing elective supratentorial craniotomy.