A comparative study between sevoflurane and propofol during intracranial surgery for assessment of rapid recovery: A randomized prospective blinded study

Background: Rapid recovery from general anaesthesia is very important factor in early postoperative neurological assessment following intracranial surgery. This study was performed to compare two different anaesthetic techniques as regards recovery profile. Methods: Forty patients, aged 20-60 years, ASA I-III undergoing intracranial surgery were randomly divided into two equal groups to receive either propofol or sevoflurane (SEVO) as a maintenance anaesthetic. The anaesthetic concentration was adjusted to maintain mean arterial blood pressure within 20% of the pre-induction baseline using either 0.5 to 1.0 minimum alveolar concentration (MAC) SEVO or propofol 50-150 μg/kg/min in combination with nitrous oxide 60% in oxygen. Remifentanil infusion was given in both study groups at a fixed rate of 0.5 μg/kg/min. Times to emergence, to extubation, to open eyes, to squeeze hand, to move feet on command, to orientation, and to discharge were recorded. Glasgow coma scale (GCS) score during recovery was also recorded. Results: SEVO group had significantly shorter times to emergence (P = 0.02), and for response to command (squeeze hand, P = 0.03; move feet, P = 0.01). Patients in SEVO group obtained a GCS score of >10 five min before patients in propofol group (P = 0.04). Times to orientation (giving name, and birth date & current location) were also shorter in SEVO group but the difference was statistically insignificant (P = 0.3, and P = 0.2 respectively). Conclusion: Both techniques used in the study provided sufficiently faster recovery to allow for early neurological examination, which is critical in neurosurgical patients. SEVO provides faster recovery characteristics than propofol.