The comparative effects of desflurane and isoflurane on intraoperative cerebral hemodynamics, cardiovascular changes, and post-operative recovery in patients undergoing craniotomy for supratentorial tumors

Abstract

Background: Preserving hemodynamic stability, providing a slack brain, and enabling early recovery are the main criteria of neuroanesthesia. The most commonly used volatile anesthetic for neurosurgeries is isoflurane due to its favorable effects on cerebral blood flow and intracranial pressure. On the other hand, desflurane, having lower blood gas partition coefficient, favors rapid recovery from anesthesia. Aims and Objectives: This study was conducted for comparing the effects of desflurane and isoflurane on intraoperative cerebral and cardiovascular hemodynamics and post-operative recovery among patients with supratentorial neoplasms posted for craniotomy. Materials and Methods: A total of 52 patients aged 20–60, ASA I and II, scheduled for craniotomy under general anesthesia, were randomized into Group I (isoflurane) and Group D (desflurane). All patients received standardized anesthetic protocol and anesthesia was maintained either with isoflurane or desflurane (≤1 MAC). Lumbar cerebrospinal fluid pressure (LCSFP) and cerebral perfusion pressure (CPP) were monitored every 5 min till dura was opened and the degree of dural tension and brain swelling were assessed by neurosurgeons, blinded to the study, at the time of dural opening. Perioperative heart rate, mean arterial pressure, and post-operative recovery time were also noted. Results: No statistically significant changes were observed among two groups regarding change in LCSFP, CPP, dural tension, brain swelling, and cardiovascular changes. Post-operative recovery time was significantly shorter in desflurane group (P<0.001) than isoflurane group. Conclusion: Desflurane and isoflurane both can be used safely in maintaining neuroanesthesia. However, due to a significantly faster recovery which facilitates early post-operative neurological assessment, desflurane may be considered a better alternative to isoflurane.

Keywords

• cerebral hemodynamics
• craniotomy
• desflurane
• isoflurane
• post-operative recovery
• supratentorial neoplasms