Effect of Propofol-Dexmedetomidine on Cerebral Oxygenation and Metabolism During Brain Tumor Resection
Condition: Brain Tumor; Surgery
MeSH terms: Brain Neoplasms
Study type: Interventional

Summary: 
      Despite theoretical benefits of intravenous 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
      intra-cranial pressure (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.
    

Detailed description: 
      The aim of this study is to evaluate the cerebral haemodaynamics and global cerebral
      oxygenation as well as the systemic haemodaynamic changes using dexmedetomidine, propofol and
      fentanyl as total intravenous anaesthestics (TIVA) in comparison with sevoflurane - fentanyl
      anesthesia in brain tumor resection.

      Indicators of global cerebral oxygenation and haemodynamics will be calculated using jugular
      bulb and peripheral arterial blood sampling.

        -  Induction: propofol, 1.5 - 2 mg/kg.

        -  Muscle Relaxants: atracurium, 0.5 mg/kg with induction and 0.1 mg/kg/20min. for
           maintenance.

        -  Cannulation: Arterial cannula: under complete aseptic conditions 20G cannula was
           inserted into the radial artery of non dominant hand after performing modified Allen's
           test and local infiltration of 0.5ml xylocaine 2%.

      Central venous catheter: A suitable central venous catheter will be inserted into Rt
      subclavian vein under complete aseptic technique, its correct position will be confirmed with
      chest X-Ray.

      Jugular bulb catheterization: Under strict sterile technique the right internal jugular vein
      will be cannulated in a retrograde technique with confirmation of the catheter tip position
      using X-Ray (C- arm). Puncture site will be at the level of cricoid cartilage behind the
      anterior border of the sternocleido-mastoid muscle.
    

Intervention name(s): Propofol-Dexmedetomidine group; Sevoflurane group
Intervention type(s): Drug; Drug
Intervention description(s): Porofol (1.5-2 mg/kg/h) infusion, Dexmedetomidine (0.2-1µg/kg/h) infusion and Fentanyl in repeated doses (50µ) when needed (heart rate or mean arterial blood pressure increase more than 20% of the basal value). Maintenance infusions will start immediately after induction.; Sevoflurane at a concentration of 2-2.5%., Fentanyl in repeated doses (50µ) when needed (heart rate or mean arterial blood pressure increase more than 20% of the basal value).
Intervention MeSH terms: Dexmedetomidine; Propofol; Sevoflurane
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Care Provider)
Primary purpose: Supportive Care