THE USE OF PROPOFOL IN 83 CONSECUTIVE PAT IENTS FOR INTRACRANIAL SURGERY

Propofol is an intravenous anesthetic agent with a short half-life all owing rapid recovery; it has cerebral hemodynamic effects similar to t hose of thiopental. The aim of the present study was to describe 83 pa tients (mean age 50,6 +/- 15,1 yrs) scheduled for intracranial surgery in whom a total intravenous anesthesia technique (TIVA) with propofol was used. 16 patients were operated in the sitting position. Mean pro pofol induction dose was 2,1 +/- 0,8 mg/kg combined with 2,3 +/- 1,8 m ug/kg of fentanyl, 1,5 mg/kg of lidocaine, and 0,08 mg/kg of vecuroniu m to facilitate intubation. Before installation of the Mayfied pin-hea d holder, the site of the pins was infiltrated with 2-3 cc of lidocain e 1 %. Anaesthesia was maintained with propofol 5,9 +/- 2,1 mg/kg/h an d fentanyl 1,6 +/- 0,65 mug/kg/h. Mean values of mean arterial pressur e and heart rate showed less than 10 % variation at intubation, applic ation of the pin-head holder and skin incision. Intracranial pressure measured by the lumbar route (after checking the patency of the CSF pa ssage from the cerebral to the spinal compartments) varied by slightly more than 10 %, starting at 11,3 +/- 6,0 mmHg before induction and 11 ,3 +/- 5,2 mmHg at intubation down to 9,5 +/- 4,5 mmHg after skin inci sion. The lumbar drainage in place allowed the surgeon to improve brai n relaxation by drawing 5-20 cc of lumbar CSF. Duration of anaesthesia was 367 +/- 96 mn from induction to extubation. From the end of propo fol infusion (at the end of the dressing) till extubation, motor respo nse and temporo-spatial orientation, 9,9 +/- 6,6 mn, 13,0 +/- 10,5 mn and 15,5 +/- 12,0 mn elapsed respectively. Mean Glasgow score was 14 a t extubation. No patient presented side-effects due to propofol admini stration nor any awarreness. In conclusion, propofol in neuroanaesthes ia insures adequate systemic and cerebral hemodynamic stability during induction, application of stimuli and maintenance of anaesthesia and allows rapid recovery which is useful for an accurate neurological eva luation during the immediate postoperative course. Propofol is thus an interesting alternative to the classical thiopental-isoflurane sequen ce.