Propofol versus thiopental by target controlled infusion in patients undergoing craniotomy.

BACKGROUND

For decades thiopental has been considered as the hypnotic drug of choice for intracranial surgery. However, total intravenous anesthesia performed with thiopental is associated with delayed recovery, whereas early post-operative neurological evaluation is critical. For this reason, target controlled infusion (TCI) of propofol is increasingly used for maintenance of anesthesia. However, a thiopental TCI has never been assessed for this purpose. We tested the hypothesis that a thiopental TCI provides an acceptable way to achieve early recovery compared to a propofol TCI during supratentorial surgery.

METHODS

Eighty patients undergoing elective craniotomy for a supratentorial tumor were randomized to receive either a propofol TCI (group P) or a thiopental TCI (group T). Both groups received a sufentanil TCI and the bispectral index was monitored. The primary end-point was time to tracheal extubation. Secondary end-points were per- and post-operative hemodynamics as well as respiratory and recovery parameters. Assessment of study end-points was performed by an intensive care specialist blinded (like the patient) to the received hypnotic.

RESULTS

Time to extubation was significantly (P<0.0001) shorter in group P (median 149 minutes; interquartile range 72-250 minutes) than in group T (median 453 minutes; interquartile range 286-813 minutes). Similarly, the recovery parameters were significantly better in group P than in group T. There was no difference between groups in terms of patient characteristics and hemodynamic parameters.

CONCLUSION

Even with TCI and bispectral index monitoring, thiopental is associated with an inappropriate delayed recovery from supratentorial surgery compared to propofol TCI.