Does hyperventilation improve operating condition during supratentorial craniotomy? A multicenter randomized crossover trial.

摘要: BACKGROUND: Hyperventilation has been an integral, but poorly validated part of neuroanesthetic practice. We conducted a two-period, crossover, randomized trial to evaluate surgeon-assessed brain bulk and measured intracranial pressure (ICP) in patients undergoing craniotomy for removal supratentorial tumors during moderate hypocapnia or normocapnia. METHODS: Two-hundred seventy-five adult with were one two treatment sequences: hyperventilation (arterial carbon dioxide tension, Paco2 25 2 mm Hg) followed by normoventilation (Paco2 37 hyperventilation. Ventilation end-tidal CO2tension kept constant 20 min. Patients also randomly assigned receive propofol infusion isoflurane anesthesia. At the end each study period, subdural ICP was neurosurgeon, blinded group, asked rate using four-point scale. RESULTS: Using generalized estimation equation model, we found that decreased risk increased 45%, P 0.004, 95% confidence intervals 22% 61%, number needed treat 8. The mean (sd) hyperventilation, 12.3 8.1 Hg, lower than normoventilation, 16.2 9.6 0.001. Anesthetic regimen did not affect assessment ICP. CONCLUSIONS: In tumors, intraoperative improves which associated decrease (Anesth Analg 2008;106:585‐94)