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NEUROSURGICAL ANESTHESIA

Mild Core Hypothermia and Anesthetic Requirement for Loss of Responsiveness During Propofol Anesthesia for Craniotomy

Outcomes Research^TM Group, Department of Anaesthesia and Pain Management, and the Department of Radiology, Royal Melbourne Hospital, Melbourne, Australia

Address correspondence to Kate Leslie, Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia. Address e-mail to kate.leslie{at}mh.org.au No reprints will be available from the authors.

Mild hypothermia may be induced during neurosurgery for brain protection. However, its effect on propofol requirement has not been defined. Accordingly, we tested the hypothesis that 3°C of core hypothermia decreases the propofol blood concentration at which patients respond to command (CP50-awake) in neurosurgical patients. Forty patients were anesthetized with alfentanil 50 µg/kg IV, nitrous oxide, propofol target-controlled infusion, and rocuronium. The bispectral index (version 3.12) was monitored continuously. Patients were randomized to a core temperature of 34°C or 37°C. At the end of surgery, neuromuscular blockade was reversed, nitrous oxide was ceased, and propofol was infused to achieve a blood target determined by the previous patient’s response. Responsiveness to command was assessed 15 min later. Results were analyzed with logistic regression models; P < 0.05 was considered statistically significant. The CP50-awake of propofol was 3.05 µg/mL (95% confidence interval, 2.34–3.66). Propofol concentration, but not core temperature, predicted loss of response to command (odds ratio, 11.76; 95% confidence interval, 2.40–57.63; P < 0.01). Core temperature did not alter the relationship between bispectral index and response to command. Propofol infusion regimens may not require adjustment during mild hypothermia.

IMPLICATIONS: Neurosurgical patients may be allowed to become mildly hypothermic during anesthesia in an effort to provide brain protection. Propofol maintenance infusion doses may not require adjustment in these patients.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999