Bispectral Index-guided Administration of Anesthesia for Transsphenoidal Resection of Pituitary Tumors: A Comparison of 3 Anesthetic Techniques

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The main aims of anesthesia for pituitary surgery include maintenance of hemodynamic stability, provision of conditions that facilitate surgical exposure, and a smooth emergence to facilitate a prompt neurologic assessment. The primary aim of our study was to compare the effects of 3 anesthetic regimens on hemodynamics and recovery characteristics of the patients. Ninety patients undergoing transsphenoidal surgery were enrolled in the study. Standard anesthesia technique was followed for induction. Patients were randomly divided to receive propofol, isoflurane, or sevoflurane for maintenance of anesthesia. The bispectral index target range during maintenance was 40 to 60. The hemodynamic variables (heart rate and mean arterial pressure) and bispectral index were noted during the various stages of the surgery. The time to emergence and extubation was noted. We evaluated cognitive function at 5 and 10 minutes posttracheal extubation. The 3 study groups were comparable with respect to age, sex, weight, and duration of surgery. We observed an increase in heart rate and blood pressure during intubation, nasal packing, and insertion of self-retaining nasal speculum. After tracheal intubation, the rise in blood pressure was more in sevoflurane group than propofol. During emergence, hypertensive response was seen in all patients. Emergence and extubation times were significantly shorter with propofol and sevoflurane. Patients who received propofol had better cognition scores. Aldrete scores were better with propofol and sevoflurane than isoflurane. The pressor response after intubation and emergence hypertension was significantly less with propofol. Better recovery profile was seen in sevoflurane and propofol groups and a better cognition in patients receiving propofol. Propofol plus nitrous oxide anesthesia could be the technique of choice in patients undergoing transnasal transsphenoidal pituitary surgery.

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