Effect of Propofol Midazolam on Cerebral Oxygenation and Metabolism During Clipping of Ruptured Cerebral Aneurysm

Not Applicable

Completed

Interventions: Drug: Total intravenous anesthesia (TIVA)
Drug: Inhalation Anesthesia
Drug: Rescue fentanyl

Brief Summary: Despite the theoretical benefits of i.v. 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 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.

Detailed Description: The aim of this study is to evaluate the cerebral hemodynamics and global cerebral oxygenation as well as the systemic hemodynamic changes using midazolam and propofol as total intravenous anesthetics (TIVA) in comparison with sevoflurane anesthesia in clipping of ruptured cerebral aneurysm.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
Total intravenous anesthesia (TIVA)	Total intravenous anesthesia (TIVA)	Patients will receive total intravenous anesthesia using Propofol and Midazolam
Total intravenous anesthesia (TIVA)	Rescue fentanyl	Patients will receive total intravenous anesthesia using Propofol and Midazolam
Inhalation Anesthesia	Inhalation Anesthesia	Patients will receive Inhalation anesthesia using Sevoflurane
Inhalation Anesthesia	Rescue fentanyl	Patients will receive Inhalation anesthesia using Sevoflurane

Primary Outcome Measures

Name	Time	Method
Arterio-Jugular oxygen content difference	Immediately before and every 30 min for 6 hour following start of surgery	The differences between arterial and jugular bulb oxygen contents
Cerebral Extraction Rate of O2 (CEO2)	Immediately before and every 30 min for 6 hour following start of surgery	Calculated as the differences between arterial and jugular bulb O2 saturations, CEO2 = SaO2 - SjvO2
Estimated cerebral metabolic rate for O2 (eCMRO2)	Immediately before and every 30 min for 6 hour following start of surgery	eCMRO2=Ca- jO2 x(PaCO2 ∕ 100), Where Ca jO2 is arterio-jugular O2 content difference. PaCO2 is arterial CO2 tension
Cerebral Blood Flow equivalent (CBFe)	Immediately before and every 30 min for 6 hour following start of surgery	: Which is an index of flow metabolism relationship, calculated as a reciprocal of arterio-jugular O2 content difference. CBFe = 1 ∕CaO2-CjvO.

Secondary Outcome Measures

Name	Time	Method
Mean arterial blood pressure	Immediately before and every 30 min for 6 hour following start of surgery
End tidal carbon dioxide tension	Immediately before and every 30 min for 6 hour following start of surgery
Central venous pressure	Immediately before and every 30 min for 6 hour following start of surgery
Sedation score	For 6 hours from induction of anesthesia	- Postoperative level of sedation of all patients will be evaluated using Ramsay sedation scale
Time for first analgesic request from extubation	For 6 hours from induction of anesthesia	Time for first analgesic request from extubation
Heart rate	Immediately before and every 30 min for 6 hour following start of surgery
Peripheral oxygen saturation	Immediately before and every 30 min for 6 hour following start of surgery
Duration of stay in intensive care unit	For 5 days after surgery