Comparison of the Quality of Recovery of patients undergoing elective Supratentorial craniotomy -Total Intravenous Anesthesia with propofol versus Balanced Anesthesia with Sevoflurane – A Randomized Controlled Trial

Craniotomies have ahigher rate of postoperative complications than the general surgical population and adversely affects thequality of life. Moreover, patients undergoing craniotomy develop postoperativecognitive and physical deficits which makes it difficult to assess thepostoperative quality of recovery.

With the advancesin imaging and surgical techniques, the focus has shifted from merelyeliminating pathology to ensuring maximal functional recovery as early aspossible. Hence anesthetic techniques in addition to providing favorableintraoperative hemodynamics and brain relaxation must ensure a good quality of recoveryto the patient as perceived by the patient.

Quality of recovery- 40 is one of the tools which helps us assess the quality of recoverypostoperatively. QoR-40 questionnaireprobes into 5different aspects of health: physical comfort, physical independence, emotionalstate, psychological support, and pain. The validity, reliability, ease of use,and responsiveness of the QoR-40 have been confirmed in the neurosurgicalpopulation in previous studies.

In the practice ofneuroanaesthesia, intravenous anesthesia with propofol and remifentanil hasbeen preferred to inhalational anesthesia in terms of brain relaxationspecifically in patients with raised intracranial pressure as it is known to lower subduralintracranial pressure,  provide highercerebral perfusion pressure, and less pronounced cerebral swelling.

However,a comparison between intravenous and inhalational anesthesia for supratentorialcraniotomy reveals that despite minimal differences, the short-term outcome interms of hemodynamic stability and intraoperative brain relaxation is notaffected in patients with normal intracranial pressure and both techniques arewidely in use.

Citerio et al in their recentmulticenter, randomized trial evaluating the equivalence of inhalational andintravenous anesthetic agents during craniotomy showed that the nearlypostoperative recovery, intraoperative hemodynamics, brain relaxation weresimilar in the 2 groups and both techniques are acceptable for craniotomies.

Studies done in thegeneral surgical population have demonstrated that TIVA with propofol providesa better quality of recovery as compared to Balanced General anesthesia.  However, there are no studies that havecompared the quality of recovery with the 2 anesthetic techniques in theneurosurgical population.

We hypothesize that BalancedGeneral Anaesthesia with Sevoflurane provides similar postoperative quality ofrecovery as compared to the use of TIVA with propofol and Fentanyl in patientsundergoing supratentorial on the 1 st and 3 rd postoperative day (assessed bythe QoR-40 questionnaire) in patients with tumors presenting for electivesupratentorial craniotomy.