Impact of Mode of Anesthesia on Ischemia Modified Albumin in Patients With Traumatic Brain Injury

Study Overview
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Brief Summary
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In the current study the investigators intend to evaluate the mode of anesthesia on ischemia modified albumin and outcome in patients with traumatic brain injury undergoing emergency craniotomy

Detailed Description
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After obtaining Institutional Ethical Committee approval and written informed consent from legally acceptable representative relatives, patients with traumatic brain injury, aged from 18- 60 years old, ASA from (I-III), GCS more than 8 undergoing emergency craniotomy surgery will be selected for this prospective randomized Study. The anesthesia will be induced with 2mcg/kg fentanyl and 2 mg/kg propofol. Muscle relaxation will be achieved with 0.5 mg/kg atracurium. Anesthesia will be maintained with: Group I, isoflurane (mac<1) mixed with oxygen 40% and fentanyl 1mcg/kg hourly. Group PD, propofol infusion(100-150mcg/kg/min) and dexmedetomedine 0.3mcg/kg /h. Parameters will be assessed Preoperative period Ischemia modified albumin level from venous sample. Basal Systolic blood pressure, diastolic blood pressure. Mean arterial blood pressure, oxygen saturation, heart rate. GCS. Intraoperative period Systolic blood pressure, diastolic blood pressure. Mean arterial blood pressure, oxygen saturation, heart rate after intubation, 5,15,30,60,90min and after extubation. Need for resuscitation with vasoactive drugs. Brain relaxation score at dural opening and closure. ICP Intraoperative blood loss. Amount of fluid and blood transfusion. Postoperative period Ischemia modified albumin immediately postoperatively, after 6h and after 24 hours. Type of surgery. Duration of surgery. Extubation time. Recovery scores (Ramsay sedation score and modified Alderte score). GCS immediately postoperatively, after 6h, after 24h and after 48 hours. Total analgesic requirement during the first 24 hours. Need for ICU admission. Length of ICU stay. Complications. 28 day mortality.

Official Title
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Impact of Mode of Anesthesia on Ischemia Modified Albumin (Abiomarker of Oxidative Stress) and Outcome in Patients With Traumatic Brain Injury Undergoing Emergency Craniotomy

Conditions
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Oxidative Stress

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 18-60 years old of both sex . Isolated traumatic brain injury undergoing emergency craniotomy. G.C.S more than 8. ASA grade (I-III). Exclusion Criteria: Non traumatic brain injury. Poly trauma patient. Coagulation disorder. Drug( alcohol, opiods, tranquilizers) addiction. Liver and kidney dysfunction. Severe diseases such as severe hypertension, cardiovascular disease, malignant tumor, autoimmune disease, mental disorders. Diabetes mellitus with poor blood glucose control. Previous drug allergy. Currently lactating.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Inhalational<br>will receive inhalational anesthesia | |
| Total intravenous<br>will receive total intravenous anesthesia with propofol infusion(100-150 mcg/kg/min) and dexmedetomedine 0.3mcg/kg/h. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| ischemia modified albumin | Plasma Level of ischemia modified albumin | change from preoperative level of ischemia modified albumin at the first 24 hours postoperatively | 
| Glascow Coma Scale | Glascow Coma Scale records the state of a person's consciousness. it gives a person's score between 3 (indicating deep unconsciousness) and 15 (indicating fully consciousness) | change from preoperative Glascow Coma Scale score at the first 24 hours postoperatively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intraoperative blood pressure. | Intraoperative haemodynamics (Systolic blood pressure in millimeter mercury, diastolic blood pressure in millimeter mercury. Mean arterial blood pressure in millimeter mercury. | preoperatively, immediatly after intubation,after 5 minutes,afer 15 minutes,after 30 minutes,after 60 minutes,after 90 minutes and immediatly after extubation. | 
| Intraoperative heart rate | Intraoperative heart rate per minute | preoperatively, immediatly after intubation,after 5 minutes,afer 15 minutes,after 30 minutes,after 60 minutes,after 90 minutes and immediatly after extubation. | 
| I.C.U admission | intensive care unit admission | up to 28 days | 
| I.C.U stay. | Length of stay in intensive care unit | up to 28 days | 
| Incidence of any complication. | Incidence of any complication (nausea, vomiting, convulsion and reopening). | up to 28 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Ischemia modified albumin, oxidative stress, traumatic brain injury