Sevoflurane versus PRopofol Combined with Remifentanil Anesthesia Impact on Postoperative Neurologic Function in Supratentorial Gliomas (SPRING): Protocol for a Randomized Controlled Trial
Authors: Xing Yan , LIN Nan , Han Ruquan , Bebawy John F , Peng Yuming , Li Jiaxin , Liu Xiaoyuan , Li Yan , Dong Jia , Zeng Min , Zhang Manyu , Nie Lanyi 
Published: July 2019

Abstract
Background

Patients with intracranial tumors are more sensitive to sedatives and general anesthetics than the general population and are therefore more susceptible to postoperative neurologic and neurocognitive dysfunction. Sevoflurane or propofol combined with remifentanil are widely used general anesthetic regimens for craniotomy, with neither regimen shown to be superior to the other in terms of neuroprotective efficacy and anesthesia quality. There is no evidence regarding the variable effects on postoperative neurologic and neurocognitive functional outcome under these two general anesthetic regimens. This trial will compare inhalational sevoflurane or intravenous propofol combined with remifentanil anesthesia in patients with supratentorial gliomas and test the hypothesis that postoperative neurologic function is equally affected between the two, as well as evaluate postoperative neurocognitive function, hemodynamics, and anesthesia quality among them.

Methods

This is a prospective, single-center, randomized parallel arm equivalent clinical trial, which is approved by China Ethics Committee of Registering Clinical Trials (ChiECRCT-20160051). Patients with supratentorial gliomas diagnosed by magnetic resonance imaging will be eligible for the trial. Written informed consent will be obtained before randomly assigning each subject to either the sevoflurane-remifentanil or propofol-remifentanil group for anesthesia maintenance to achieve an equal-desired depth of anesthesia. Intraoperative intervention and monitoring will follow a standard anesthetic management protocol. All of the physiological parameters and other medications administered during the intervention will be recorded. The primary outcome will be neurologic function assessed by National Institute of Health Stroke Scale (NIHSS) and modified NIHSS within two days after general anesthesia. Secondary outcomes will include hemodynamic stability, intraoperative brain relaxation, quality of anesthesia emergence, quality of anesthesia recovery, postoperative cognitive function, postoperative pain, postoperative neurologic complications, perioperative medical expense, as well as blood and urine stress response biomarkers.

Discussion

This randomized equivalency trial will primarily compare the impacts of sevoflurane-remifentanil and propofol-remifentanil anesthesia on short-term postoperative neurologic function in patients with supratentorial gliomas undergoing craniotomy. The exclusion criteria are strict to ensure that the groups are comparable in all aspects. Repeated and routine neurologic evaluations after operation are always important to evaluate neurosurgical patients’ recovery and any newly presenting complications. The results of this trial would help specifically to interpret anesthetic residual effects on postoperative outcomes, and perhaps would help the anesthesiologist to select the optimal anesthetic regimen to minimize its impact on neurologic function in this specific patient population.