Propofol versus thiopental by target controlled infusion in patients undergoing craniotomy.

BACKGROUND: For decades thiopental has been considered as the hypnotic drug of choice for intracranial surgery. However, total intravenous anesthesia performed with thiopental is associated with delayed recovery, whereas early post-operative neurological evaluation is critical. For this reason, target controlled infusion (TCI) of propofol is increasingly used for maintenance of anesthesia. However, a thiopental TCI has never been assessed for this purpose. We tested the hypothesis that a thiopental TCI provides an acceptable way to achieve early recovery compared to a propofol TCI during supratentorial surgery.

METHODS: Eighty patients undergoing elective craniotomy for a supratentorial tumor were randomized to receive either a propofol TCI (group P) or a thiopental TCI (group T). Both groups received a sufentanil TCI and the bispectral index was monitored. The primary end-point was time to tracheal extubation. Secondary end-points were per- and post-operative hemodynamics as well as respiratory and recovery parameters. Assessment of study end-points was performed by an intensive care specialist blinded (like the patient) to the received hypnotic.

RESULTS: Time to extubation was significantly (P<0.0001) shorter in group P (median 149 minutes; interquartile range 72-250 minutes) than in group T (median 453 minutes; interquartile range 286-813 minutes). Similarly, the recovery parameters were significantly better in group P than in group T. There was no difference between groups in terms of patient characteristics and hemodynamic parameters.

CONCLUSION: Even with TCI and bispectral index monitoring, thiopental is associated with an inappropriate delayed recovery from supratentorial surgery compared to propofol TCI.