Effects of Anesthetic Management on Early Postoperative Recovery, Hemodynamics and Pain After Supratentorial Craniotomy

Eugenia Ayrian, Alan David Kaye, Chelsia L Varner, Carolina Guerra, Nalini Vadivelu, Richard D Urman, Vladimir Zelman, Philip D Lumb, Giovanni Rosa, Federico Bilotta, Eugenia Ayrian, Alan David Kaye, Chelsia L Varner, Carolina Guerra, Nalini Vadivelu, Richard D Urman, Vladimir Zelman, Philip D Lumb, Giovanni Rosa, Federico Bilotta

Abstract

Various clinical trials have assessed how intraoperative anesthetics can affect early recovery, hemodynamics and nociception after supratentorial craniotomy. Whether or not the difference in recovery pattern differs in a meaningful way with anesthetic choice is controversial. This review examines and compares different anesthetics with respect to wake-up time, hemodynamics, respiration, cognitive recovery, pain, nausea and vomiting, and shivering. When comparing inhalational anesthetics to intravenous anesthetics, either regimen produces similar recovery results. Newer shorter acting agents accelerate the process of emergence and extubation. A balanced inhalational/intravenous anesthetic could be desirable for patients with normal intracranial pressure, while total intravenous anesthesia could be beneficial for patients with elevated intracranial pressure. Comparison of inhalational anesthetics shows all appropriate for rapid emergence, decreasing time to extubation, and cognitive recovery. Comparison of opioids demonstrates similar awakening and extubation time if the infusion of longer acting opioids was ended at the appropriate time. Administration of local anesthetics into the skin, and addition of corticosteroids, NSAIDs, COX-2 inhibitors, and PCA therapy postoperatively provided superior analgesia. It is also important to emphasize the possibility of long-term effects of anesthetics on cognitive function. More research is warranted to develop best practices strategies for the future that are evidence-based.

Keywords: Anesthesia; Cognitive recovery; Craniotomy; Neuroanesthesia; Postoperative recovery; Supratentorial.

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