Discussion
intracranial hypertension, tachycardia, supratentorial tumors, edema, PONV, neurological deficits, hematoma
VASODILATION, EDEMA, HEMATOMA, CEREBRAL INFARCTION, COMPLICATIONS
Our study suggested that desflurane anesthesia and TIVA provide similar brain relaxation in patients undergoing craniotomy for supratentorial tumors without intracranial hypertension.Several studies have demonstrated propofol decrease ICP by reducing CBF and CBV simultaneously [Multiple factors may account for our major finding. First, the cerebral vasodilation effect of desflurane is dose-dependent. Low-dose desflurane decreases global CBF by suppressing cerebral metabolism. As the concentration increases, the direct vasodilation effect begins to dominate and may increase CBF, while these effects were mainly observed at concentrations of 1.0 MAC and above [The multivariate analysis revealed that peritumoral edema is associated with unsatisfactory brain relaxation, which is consistent with previous findings [The present study also found that, compared with TIVA, desflurane anesthesia provides patients with faster emergence and better recovery of cognitive function. In clinical practice, rapid recovery is desirable in neurosurgery because it allows for early neurological assessment and prompt detection of potential complications, such as hematoma formation, acute cerebral infarction, and neurological deficits. This contributes to rapid diagnosis and intervention and may improve patients’ clinical outcomes [Recovery complications were similar between the two groups, except for PONV and tachycardia. Patients assigned to the desflurane group experienced more PONV than those in the TIVA group even though we administered 5 mg of dexamethasone combined with 8 mg of ondansetron to prevent PONV. A recent review suggested that 8 mg of dexamethasone may significantly enhance the antiemetic effect, which could be tested in future studies [Our study has several limitations. First, we did not supplement any objective measures to evaluate brain relaxation, such as subdural pressure and cerebrospinal fluid pressure monitoring, but only a subjective evaluation by the neurosurgeons. However, the standardized 4-point scale is the most practical and accessible measurement to evaluate brain relaxation, and it has been widely applied in many clinical studies [