A comparative evaluation of the efficacy of propofol versus the combination of propofol and phenylephrine in maintaining hemodynamic stability during induction of general anaesthesia in neurosurgical patients

In neurosurgical patients, the goals of anaesthesia include the maintenance of adequate cerebral oxygenation, cerebral perfusion pressure (CPP), stable hemodynamics, brain relaxation and avoidance of techniques or agents that affect these factors.The haemodynamic stability is mainly important for most neurosurgical procedures, especially aneurysmal clipping, where maintaining a transmural pressure gradient is of utmost importance to prevent its rupture

Several agents, both inhalational and intravenous (IV), have been used for the induction and maintenance of anaesthesia in neurosurgery patients. Propofol is a very commonly used sedative agent which induces general anaesthesia by facilitation of inhibitory neurotransmission mediated by gamma�’aminobutyric acid.The hypotensive action of propofol has been linked to affect the cerebral perfusion pressure and hence many approaches have been used to mitigate the hypotensive episode.Phenylephrine has emerged as a promising vasopressor drug since its discovery in 1927 and is commonly used for mitigating the hypotension associated with propofol induction

Various studies using different concentrations of phenylephrine have been used in preventing hypotension in healthy adult patients, but we could not find any such study on neurosurgical patients where maintaining hemodynamics is very important.The hypothesis of this study is that combination of propofol and phenylephrine will provide a better intraoperative hemodynamic profile in neurosurgical patients compared to the standard propofol alone induction.

The aim of this study is to compare the efficacy of propofol versus the combination of propofol and phenylephrine in maintaining hemodynamic stability during induction in neurosurgical patients.