Comparison of Total Intravenous Anesthesia vs. Inhalational Anesthesia in Acute Subdural Hematoma Patients
Condition: Acute Subdural Hematoma
MeSH terms: Hematoma, Subdural; Hematoma, Subdural, Acute; Hematoma
Study type: Interventional
Phase: Phase 4

Summary: 
      Consent will be taken from the relatives and the patient will be taken to the operating room.
      Inside the operation theatre patient will be shifted to operating table and standard monitors
      will be attached. The patient will then be given induction agent to make him/her unconscious
      and unaware of the surrounding and muscle relaxant to prevent movement will be administered.
      He/she will be intubated with appropriate size tube to maintain airway. In order to maintain
      anesthesia he/ she will be given either of inhalational or intravenous anesthetic throughout
      the surgery. Intracranial pressure will be measured using venflon needle as soon as burr hole
      is created in the skull. Throughout the surgery patients vital parameters will be monitored
      and appropriate treatment will be given in case if the vitals are not stable.
    

Detailed description: 
      Patients meeting inclusion criteria will be enrolled in the study and randomized into one of
      the two group's propofol - P and isoflurane - I. Preoperative Glasgow coma scale (GCS) and
      computer tomography (CT) findings will be recorded. Intraoperatively peripheral intravenous
      line will be secured, standard monitors including non invasive blood pressure (NIBP),
      electrocardiogram (ECG), heart rate (HR), pulse oximetry, SPO2 probe will be connected.
      Pre-oxygenation will be done with 100% O2 for 3 minutes. In both the groups induction will be
      done using 3 mcg/kg fentanyl, 2 mg/kg propofol and muscle relaxation will be achieved with
      0.1mg/kg vecuronium. Post induction patients will be intubated with appropriate size
      endotracheal tube (male with 8.0 and female with 7.0) and radial artery will be cannulated
      with zero pressure adjustment at mid axillary line for continuous blood pressure monitoring
      and blood sampling. Central line will be secured using 7 French triple lumen central venous
      catheter in the subclavian vein or internal jugular vein. Cardiac output monitor (EV1000)
      will be connected to arterial and central line and values of stroke volume (SV), systemic
      vascular resistance (SVR), cardiac output (CO) and cardiac index (CI) will be obtained.
      Intraoperative anesthesia will be maintained using propofol 100-150 mcg/kg/min, oxygen and
      air and FiO2 of 40% in propofol group (GROUP P) whereas in isoflurane group (GROUP I)
      maintenance will be done with 1 MAC of isoflurane, oxygen and air and FiO2 of 40%. In both
      the groups Etco2 will be maintained at 32-33 mmHg. HR and IBP will be kept within +/- 20% of
      the baseline values. If the systolic blood pressure decreases more 20% of base line,
      crystalloids will be given as initial management and failing to improve blood pressure,
      vasopressors namely phenylephrine or dopamine will be given intravenously. At the time of
      scalp incision mannitol 1 gm/kg will be given over 20min. On creating first burr hole a
      22G/0.8mm venflon cannula will be placed under dura and connected to a pressure transducer
      system via a polyethylene catheter. Zero level of ICP will be adjusted with the transducer
      kept at the level of mastoid process(6). The pressure measured will be the estimate for
      intracranial pressure. Cerebral perfusion pressure (CPP) will be calculated as the difference
      between mean arterial pressure MAP and ICP. If the intracranial pressure is more than 25 mmHg
      then moderate hyperventilation will be given with Etco2 of 25-28 mmHg. Once the dura is
      opened brain relaxation score will be assessed on four point scale, using tactile evaluation
      by neurosurgeon who will be blinded to anaesthetic technique. The tension will be categorized
      as follows:

        1. Perfectly relaxed

        2. Satisfactorily relaxed

        3. Firm brain

        4. Bulging brain Meanwhile hemodynamic stability in terms of heart rate, blood pressure,
           MAP, cardiac output, stroke volume , stroke volume variation, systemic vascular
           resistance, cardiac index, and cerebral perfusion pressure will be measured before
           induction, at the time of induction and at 1 , 2, 3, 4, 5th minute after induction and
           thereafter every 15 minutes until surgery is completed.
    

Intervention name(s): Propofol; Isoflurane
Intervention type(s): Drug; Drug
Intervention description(s): Intraoperative anesthesia will be maintained using propofol 100-150 mcg/kg/min, oxygen and air and FiO2 of 40% in propofol group (GROUP P); in(GROUP I) maintenance will be done with 1 MAC of isoflurane, oxygen and air and FiO2 of 40%.
Intervention MeSH terms: Propofol; Isoflurane
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Care Provider)
Primary purpose: Supportive Care