• Gediminas Banevičius, Danguolė Rugytė, Andrius Macas, Arimantas Tamašauskas, and Edgaras Stankevičius.
• Department of Anesthesiology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, Kaunas, Lithuania. gediminasbanevicius@yahoo.com
• Medicina (Kaunas). 2010 Jan 1;46(11):743-52.

UnlabelledHemodynamic effects during cerebral tumor resection surgery under monitoring the depth of anesthesia and during recovery in sevoflurane- or propofol-anesthetized patients have not been previously compared.ObjectiveTo compare cerebral hemodynamic changes using transcranial Doppler sonography during sevoflurane or propofol anesthesia under state entropy (SE) monitoring, and during recovery period.Material And MethodsIn a randomized manner, 130 patients received sevoflurane (group T-S) or propofol (group T-P) to maintain SE at 40-50. Cerebral blood flow velocity (Vmean) in the middle cerebral artery was evaluated at baseline, after tracheal intubation, opening of the dura mater, tumor resection, skin closure, extubation, and two hours after extubation. Cerebrovascular resistance index (RAP), estimated cerebral perfusion pressure (eCPP), and cerebral blood flow index (CBFI) were calculated off-line.ResultsDuring surgery SE was 40.6 (SD, 8.1) in the group T-S and 44.0 (SD, 7.4) in the group T-P. Blood pressure was significantly higher in the group T-P. Compared to the baseline, Vmean decreased by 16.6% and 23.5% in the groups T-S and T-P, respectively (P<0.05). RAP and eCPP were higher in the group T-P versus the group T-S: 28.9% and 5.2%, respectively, above the baseline for RAP (P<0.005) and 3.2% and 16.9% below the baseline for eCPP (P<0.005). CBFI was below the baseline by 20.1% and 24.0% in the groups T-S and T-P, respectively (P>0.05). After the extubation and 2 hours later, Vmean recovered comparably with no differences in RAP, eCPP, or CBFI between the two groups.ConclusionsAt the comparable depth of anesthesia for intracranial tumors surgery and during recovery, sevoflurane had no major effect on cerebral circulation measured by transcranial Doppler sonography as compared with propofol. Our results add to current knowledge on the safety of sevoflurane in neuroanesthesia.

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