Effect of Propofol Midazolam on Cerebral Oxygenation and Metabolism During Clipping of Ruptured Cerebral Aneurysm

Mansoura University

Status: Completed

Conditions: Ruptured Cerebral Aneurysm

Treatments: Drug: Total intravenous anesthesia (TIVA); Drug: Rescue fentanyl; Drug: Inhalation Anesthesia

Study type: Interventional

Funder types: Other

Identifiers

NCT03778723

MD ∕17.08.07

Details and patient eligibility

About

Despite the theoretical benefits of i.v. agents, volatile agents remain popular. In a study comparing desflurane, isoflurane, and sevoflurane in a porcine model of intracranial hypertension, at equipotent doses and normocapnia, cerebral blood flow (CBF) and ICP were least with sevoflurane.

Propofol is the most commonly used intravenous anesthetic. It has many theoretical advantages by reducing cerebral blood volume (CBV) and ICP and preserving both autoregulation and vascular reactivity. Neurosurgical patients anaesthetized with propofol were found to have lower ICP and higher CPP than those anaesthetized with isoflurane or sevoflurane.

The well known pharmacodynamic advantages of intravenous anesthetics may give this group of drugs superior cerebral effects when compared with inhalation anesthetics.

Full description

The aim of this study is to evaluate the cerebral hemodynamics and global cerebral oxygenation as well as the systemic hemodynamic changes using midazolam and propofol as total intravenous anesthetics (TIVA) in comparison with sevoflurane anesthesia in clipping of ruptured cerebral aneurysm.

Enrollment: 50 patients

Sex: All

Ages: 20 to 60 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• American Society of Anesthesiologists physical status III or IV.

Exclusion criteria

• Morbid obese patients.
• Severe or uncompensated cardiovascular diseases
• Severe or decompensated renal diseases
• Severe or decompensated hepatic diseases
• Severe or decompensated endocrinal diseases.
• Pregnancy
• Postpartum
• Lactating females
• Allergy to one of the agents used.
• Severely altered consciousness level.
• Sitting or prone position during surgery.

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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50 participants in 2 patient groups

Total intravenous anesthesia (TIVA)

Experimental group

Description:

Patients will receive total intravenous anesthesia using Propofol and Midazolam

Treatment:

Drug: Total intravenous anesthesia (TIVA)

Drug: Rescue fentanyl

Inhalation Anesthesia

Active Comparator group

Description:

Patients will receive Inhalation anesthesia using Sevoflurane

Treatment:

Drug: Inhalation Anesthesia

Drug: Rescue fentanyl