A comparative study of desflurane inhalation and propofol TCI regimen for temporal lobectomy: Early recovery, cognitive functions and costs

Abstract

Background : A number of the anesthesia regimens are used in craniotomy. Rapid emergence is one of the important goals in Neuroanesthesia. In this study, we compared desflurane inhalation and propofol TCI regimen in patients undergoing craniotomy for temporal lobectomy regarding recovery profiles including time of recovery, cognitive function, postoperative pain, post-operative nausea and vomiting (PONV). In addition, we compared the costs between the two regimens.

Objective : To study effects of desflurane inhalation regimen and propofol TCI in patients undergoing elective craniotomy for temporal lobectomy. Recovery profiles, post-operative complications and treatments and overall costs between two group are compared

Design : Randomized double-blind prospective study

Setting : Neurosurgery and Neuroanesthesia unit at King Chulalongkorn Memorial Hospital.

Materials and Method : Forty-two patients were randomly assigned into group D with desflurane inhalation and group P with propofol TCI. Anesthetic depth was controlled by bispectral index (BIS). Time to awakening, cognitive function using Mini-Mental Status Exam (MMSE-Thai version), pain score and PONV were documented. Clinical symptoms and recovery profiles of all patients were followed up until 24 hours postoperatively.

Results : Time from discontinuing anesthesia to eyes opening was faster in group D than group P (5.20 2.91 vs. 8.90 4.64 min). However, times to extubation and orientation were similar. There were no statistically significant differences in Post- Anesthesia Recovery Scores (PARS), discharge times or MMSE scores between the two groups. More Significant number of patients suffered from PONV in group D than group P (45% vs. 4%). Pain scores and shivering needed to be treated; 24-hour MMSE scores were not different. However, overall costs were significantly higher in group P than group D (2924.88 vs.1474.34 Thai Baht).

Conclusion : Patients in both groups showed similar emergence and recovery profiles. However, the costs of propofol TCI regimen were significantly higher than that of desflurane inhalation group.