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NEUROSURGICAL ANESTHESIOLOGY AND NEUROSCIENCE

The Effect of Sedation on Intracranial Pressure in Patients with an Intracranial Space-Occupying Lesion: Remifentanil Versus Propofol

Francois Girard, MD, FRCPC^*, Robert Moumdjian, MD, FRCSC, Daniel Boudreault, MD, FRCPC^*, Philippe Chouinard, MD, FRCPC^*, Alain Bouthilier, MD, FRCSC, and Monique Ruel, RN^*

From the *Department of Anesthesiology, and Neurosurgery Division, Centre Hospitalier de l’Université de Montréal, Hôpital Notre-Dame, Montreal, Canada.

Address correspondence to François Girard, MD, FRCPC, Department of Anesthesiology, CHUM, Hôpital Notre-Dame, 1560 Sherbrooke East, Montreal, Canada, H2L 4M1. Address e-mail to francois.girard.chum{at}ssss.gouv.qc.ca.

Abstract

BACKGROUND: In this study, we compared the effect of light sedation with remifentanil versus propofol on intracranial (ICP) and cerebral perfusion pressure (CPP) of patients undergoing stereotactic brain tumor biopsy under regional anesthesia.

METHODS: This was a prospective, open-label, randomized, and controlled study. Forty patients undergoing stereotactic brain tumor biopsy under regional anesthesia were randomized into two groups to receive remifentanil or propofol titrated to a level of four on the modified Assessment of Alertness/Sedation Scale. ICP was measured via the biopsy needle.

RESULTS: At the targeted level of sedation, the rates of infusion for remifentanil and propofol were, respectively, 4.2 ± 1.8 µg · kg^–1 · h^–1 and 4.3 ± 2.5 mg · kg^–1 · h^–1. At the time of ICP measurement, patients in the remifentanil group had a slower respiratory rate (11/min ± 3 vs 15 per min ± 3, P = 0.0001) and a higher Pco₂ (48.3 ± 6.2 mm Hg vs 43.1 ± 5.5 mm Hg, P = 0.009) than patients in the propofol group. The mean was similar for both groups, 19.0 ± 11.9 mm Hg vs 16.4 ± 11.1 mm Hg for remifentanil and propofol, respectively (P = 0.48). Higher mean arterial blood pressure in the remifentanil group (101.1 ± 13.7 mm Hg vs 85.8 ± 12.7 mm Hg, P = 0.0008) resulted in a higher CPP than the propofol group: 82.0 ± 19.0 mm Hg vs 69.5 ± 17.0 ± 19.0 mm Hg (P = 0.03).

CONCLUSION: Light sedation with remifentanil does not result in a higher ICP than propofol in patients undergoing stereotactic brain tumor biopsy. CPP might be better preserved with remifentanil.