Why we still use intravenous drugs as the basic regimen for neurosurgical anaesthesia

被引:71
作者
Hans, Pol [1 ]
Bonhomme, Vincent [1 ]
机构
[1] Liege Univ Hosp, CHR Citadelle, Univ Dept Anaesthesia & Intens Care Med, Liege, Belgium
关键词
intravenous agents; neurosurgery; neurosurgical anaesthesia; propofol;
D O I
10.1097/01.aco.0000245274.69292.ad
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Purpose of review Evolution of neurosurgery mainly trends towards minimally invasive and functional procedures including endoscopies, small-size craniotomies, intraoperative imaging and stereotactic interventions. Consequently, new adjustments of anaesthesia should aim at providing brain relaxation, minimal interference with electrophysiological monitoring, rapid recovery, patients' cooperation during surgery and neuroprotection. Recent findings In brain tumour patients undergoing craniotomy, propofol anaesthesia is associated with lower intracranial pressure and cerebral swelling than volatile anaesthesia. Hyperventilation used to improve brain relaxation may decrease jugular venous oxygen saturation below the critical threshold. It decreases the cerebral perfusion pressure in patients receiving sevoflurane, but not in those receiving propofol. The advantage of propofol over volatile agents has also been confirmed regarding interference with somatosensory, auditory and motor evoked potentials. Excellent and predictable recovery conditions as well as minimal postoperative side-effects make propofol particularly suitable in awake craniotomies. Finally, the potential neuroprotective effect of this drug could be mediated by its antioxidant properties which can play a role in apoptosis, ischaemia-reperfusion injury and inflammatory-induced neuronal damage. Summary Although all the objectives of neurosurgical anaesthesia cannot be met by one single anaesthetic agent or technique, propofol-based intravenous anaesthesia appears as the first choice to challenge the evolution of neurosurgery in the third millennium.
引用
收藏
页码:498 / 503
页数:6
相关论文
共 54 条
[1]   Propofol inhibits caspase-3 in astroglial cells: Role of heme oxygenase-1 [J].
Acquaviva, R ;
Campisi, A ;
Raciti, G ;
Avola, R ;
Barcellona, ML ;
Vanella, L ;
Volti, GL .
CURRENT NEUROVASCULAR RESEARCH, 2005, 2 (02) :141-148
[2]  
Acquaviva R, 2004, ANESTHESIOLOGY, V101, P1363
[3]   Neuroprotective effects of propofol in models of cerebral ischemia - Inhibition of mitochondrial swelling as a possible mechanism [J].
Adembri, C ;
Venturi, L ;
Tani, A ;
Chiarugi, A ;
Gramigni, E ;
Cozzi, A ;
Pancani, T ;
De Gaudio, RA ;
Pellegrini-Giampietro, DE .
ANESTHESIOLOGY, 2006, 104 (01) :80-89
[4]  
[Anonymous], 2004, CHIN MED J
[5]   Propofol attenuates lung endothelial injury induced by ischemia-reperfusion and oxidative stress [J].
Balyasnikova, IV ;
Visintine, DJ ;
Gunnerson, HB ;
Paisansathan, C ;
Baughman, VL ;
Minshall, RD ;
Danilov, SM .
ANESTHESIA AND ANALGESIA, 2005, 100 (04) :929-936
[6]   Propofol neuroprotection in cerebral ischemia and its effects on low-molecular-weight antioxidants and skilled motor tasks [J].
Bayona, NA ;
Gelb, AW ;
Jiang, ZB ;
Wilson, JX ;
Urquhart, BL ;
Cechetto, DF .
ANESTHESIOLOGY, 2004, 100 (05) :1151-1159
[7]   Monitored anesthesia care using remifentanil and propofol for awake craniotomy [J].
Berkenstadt, H ;
Perel, A ;
Hadani, M ;
Unofrievich, I ;
Ram, Z .
JOURNAL OF NEUROSURGICAL ANESTHESIOLOGY, 2001, 13 (03) :246-249
[9]   The effects of isoflurane and propofol on intraoperative neurophysiological monitoring during spinal surgery [J].
Chen Z. .
Journal of Clinical Monitoring and Computing, 2004, 18 (4) :303-308
[10]   The effects of propofol, small-dose isoflurane, and nitrous oxide on cortical somatosensory evoked potential and bispectral index monitoring in adolescents undergoing spinal fusion [J].
Clapcich, AJ ;
Emerson, RG ;
Roye, DP ;
Xie, H ;
Gallo, EJ ;
Dowling, KC ;
Ramnath, B ;
Heyer, EJ .
ANESTHESIA AND ANALGESIA, 2004, 99 (05) :1334-1340