Aken et al., 1990 [27][35] |
Unspecified cranial procedure |
Balanced anesthesia (loading thiopental and fentanyl + maintenance fentanyl, droperidol, thiopental, and isoflurane in nitrous oxide, n = 20) vs. TIVA (loading propofol + alfentanil infusion, n = 20) |
During induction, TIVA had a significantly greater hemodynamic stability. Balance anesthesia was associated with a significantly longer emergence time than TIVA. |
Hemelrijck et al., 1991 [23][30] |
Craniotomy for resection of brain tumor |
Propofol (n = 20) vs. thiopental (n = 20) |
Postoperative return to orientation time was shorter in the propofol group (7 +/− 5 min vs. 27 +/− 23 min). |
Ornstein et al., 1993 [28][36] |
Craniotomy for resection of supratentorial lesion |
Anesthetic maintenance via desflurane (n = 12) vs. isoflurane (n = 12) |
CBF values were non-significantly different as measured at 1 MAC and 1.5 MAC concentrations for both desflurane and isoflurane (p > 0.05), as well as at 1.25 MAC as measured in n = 15 patients (p > 0.05). |
Talke et al., 1996 [29][37] |
Hypophysectomy |
Propofol (n = 10) vs. loading propofol + maintenance desflurane (n = 10) vs. loading propofol + maintenance isoflurane (n = 10) |
Minimum CPP was significantly lower in desflurane (p < 0.05) and isoflurane (p < 0.05) groups compared to propofol-only control. Minimum SBP was significantly lower in desflurane (p < 0.05) and isoflurane (p < 0.05) compared to propofol-only control. |
Artru et al., 1997 [30][38] |
Unspecified cranial procedure |
Anesthetic maintenance via sevoflurane (n = 8) and isoflurane (n = 6) following induction via mannitol |
Neither sevoflurane or isoflurane significantly altered ICP, and both decreased middle cerebral artery flow velocity (Vmca). Notably, decreased Vmca with sevoflurane was related to decreased CPP at 0.5 MAC (p < 0.05), and increased CVRe at 1.0 and 1.5 MAC (p < 0.05). The CPP decreased from baseline at 0.5, 1.0, and 1.5 MACs of isoflurane (p < 0.05). |
Hoffman et al., 1998 [31][39] |
Craniotomy for unspecified pathology |
Thiopental induction (n = 10) vs. desflurane (n = 10) |
Neither thiopental nor desflurane changed tissue gases or pH, but desflurane increased PO2 70% (p < 0.05), whereas thiopental decreased PO2 30% during temporary brain artery occlusion. |
Talke et al., 1999 [32][40] |
Transsphenoidal Hypophysectomy |
Anesthetic maintenance via propofol (n = 10) vs. sevoflurane (n = 20) |
Sevoflurane increased lumbar CSF pressure and decreased CPP and systolic blood pressure following infusion while propofol did not affect lumbar CSF pressure, CPP, nor systolic blood pressure. |
Talke et al., 2002 [26][33] |
Craniotomy for resection of supratentorial lesion |
Propofol (n = 20) vs. isoflurane (n = 20) |
Emergence time to eyes opening was not different between anesthetic agents (p > 0.05). There was no difference in occurrence of hypertension (p > 0.05). |
Iwata et al., 2003 [33][41] |
Unspecified intracranial surgery |
Propofol (n = 13) vs. sevoflurane (n = 13) |
There was no difference in the rate of temperature decrease and recovery in induced hypothermia (p < 0.05). |
Fraga et al., 2003 [34][42] |
Craniotomy for resection of supratentorial lesion |
Inhalation of isoflurane (n = 30) vs. desflurane (n = 30) following induction via fentanyl, thiopental, and vecuronium maintained with 60% nitrous oxide in oxygen |
There were no significant differences between MAP, ICP, and CPP between use of desflurane and isoflurane, but notable decreases (p < 0.05) in both groups from baseline values with regard to MAP and CPP. The ratio between the cerebral metabolic oxygen requirement and cerebral blood flow decreased significantly for both groups as well. |
Petersen et al., 2003 [24][31] |
Craniotomy for resection of supratentorial tumor |
Propofol (n = 41) vs. isoflurane (n = 38) vs. sevoflurane (n = 38) |
No differences in ICP or CPP between anesthetic agents (p > 0.05). |
Günes et al., 2005 [35][43] |
Unspecified intracranial procedure |
Anesthetic maintenance via propofol (n = 39) vs. dexmedetomidine (n = 39) |
Systolic blood pressure and MAP were not different between the two agents. Extubation time was shorter for propofol (p < 0.05). Analgesic requirements were higher for propofol (p = 0.013). |
Magni et al., 2005 [25][32] |
Supratentorial craniotomy for unspecified pathology |
Propofol (n = 64) vs. sevoflurane (n = 64) |
Emergence time was not different between anesthetic agents. Occurrence of hypertension was higher in propofol than sevoflurane use (p = 0.0046), and hypotension was higher in propofol than sevoflurane (p = 0.02). |
Sekimoto et al., 2006 [36][44] |
Craniotomy for resection of brain tumor |
Anesthetic maintenance via halothane vs. isoflurane vs. sevoflurane after induction via propofol/fentanyl/nitrous oxide |
Halothane, isoflurane, and sevoflurane were all found to reduce systolic blood pressure, but only sevoflurane and isoflurane decreased train-of-four ratios significantly at 1.0 MAC (p < 0.001). Amplitudes of transcranial motor-evoked potentials were reduced by isoflurane and sevoflurane at 0.5 MACs, but not halothane, reflecting the reduced extent of the neuromuscular blockade initiated by halothane. |
Djian et al., 2006 [37][45] |
Unspecified intracranial procedure |
Remifentanil vs. sufentanil in combination with propofol for maintenance of anesthesia |
Remifentanil was associated with the need for less adjustments with regard to hemodynamic stability (p = 0.037), greater use of morphine (p = 0.01), and higher intraoperative opioid costs. However, there was no significant differences in extubation times between groups. |
Bhagat et al., 2008 [38][46] |
Craniotomy for unspecified pathology |
Anesthetic maintenance via propofol (n = 50) vs. isoflurane (n = 50) |
Hypertension occurrence and MAP change were not different between the two agents. Emergence time was higher for propofol (p = 0.008). |
Bonhomme et al., 2009 [39][47] |
Unspecified intracranial procedure |
Propofol (n = 30) vs. sevoflurane (n = 31) |
Propofol was associated with higher occurrence of intraoperative hypertension (p < 0.001) and sevoflurane was associated with higher occurrence of intraoperative hypotension (p = 0.015). |
Ali et al., 2009 [40][48] |
Resection of pituitary tumor |
Propofol (n = 30), isoflurane (n = 30), sevoflurane (n = 30) |
Emergence time was significantly longer with use of isoflurane (p < 0.001). Hypertension occurrence was higher in isoflurane than in propofol or sevoflurane, and higher in sevoflurane than propofol (p < 0.001). Hypotension was not difference between anesthetics (p = 0.36). |
Bilotta et al., 2009 [41][49] |
Craniotomy for resection of supratentorial lesion |
Sevoflurane (n = 28) vs. desflurane (n = 28) |
Significant delays in cognitive “awakening” for obese and overweight patients receiving sevoflurane-based anesthesia as compared to those receiving desflurane-based anesthesia as measured by post-operative short orientation memory concentration test scores at 15 and 30 min (p < 0.005, p < 0.005) as well as with the Rancho Los Amigos scale (p < 0.005) |
Güneş et al., 2009 [63][71] |
Craniotomy for resection of supratentorial lesion |
Anesthetic maintenance with dexmedetomidine in addition to sevoflurane (n = 30), desflurane (n = 30), and isoflurane (n = 30) |
MAP was elevated following intubation for all groups. Rates of eyes opening and responsiveness following verbal commands were lower in desflurane–dexmedetomidine than in other groups (p = 0.001). |
Magni et al., 2009 [64][72] |
Craniotomy for resection of supratentorial lesion |
Anesthetic maintenance via sevoflurane (n = 60) vs. desflurane (n = 60) |
Mean emergence was similar between the two groups, but extubation and recovery time were lower (p < 0.001) in the desflurane group. Hemodynamic stability differences were non-significant between the two groups. |
Lauta et al., 2010 [42][50] |
Craniotomy for resection of supratentorial lesion |
Anesthetic maintenance via propofol (n = 153) vs. sevoflurane (n = 149) |
Propofol was associated with a significantly longer emergence time to eyes opening (p < 0.014. Sevoflurane was associated with higher occurrence of hypotension (p < 0.0167). |
Yildiz et al., 2011 [43][51] |
Craniotomy for resection of supratentorial lesion |
Anesthetic maintenance via desflurane (n = 35) vs. isoflurane (n = 35) |
Heart rate was not different between the two agents. MAP was higher for desflurane (p < 0.05). Extubation time and eyes opening time was shorter for desflurane (p < 0.05). |
Ghoneim et al., 2015 [44][52] |
Craniotomy for resection of supratentorial tumors |
Anesthetic maintenance via isoflurane (n = 20) vs. sevoflurane (n = 20) vs. desflurane (n = 20) |
Emergence times were significantly shorter for desflurane or sevoflurane than with isoflurane in pediatric patients following a craniotomy for supratentorial tumors. |
Hernandez et al., 2015 [45][53] |
Craniotomy for hematoma |
Anesthetic maintenance via propofol (n = 20) or sevoflurane (n = 20) |
SSEPs amplitudes and latencies were not different between the two agents. TceMEPs amplitudes were higher for propofol (p < 0.05). Latencies were shorter in the propofol group (p < 0.05). |
Goettel et al., 2016 [46][54] |
Awake craniotomy for unspecified pathology |
Dexmedetomidine (n = 25) vs. propofol (n = 25) |
There were no differences in level of sedation (OAA) (p = 0.13). There were no differences in intraoperative hypertension (p = 0.60), hypotension (p = 0.50), or complications (p = 0.99). There was no difference in postoperative complications (p > 0.05). |
Gokcek et al., 2016 [47][55] |
Unspecified intracranial procedure |
Anesthetic maintenance via sevoflurane (n = 25) vs. desflurane (n = 25) |
Emergence time and time to eyes opening were higher with sevoflurane (p < 0.001). |
Lin et al., 2016 [48][56] |
Resection of supratentorial lesion |
Anesthetic maintenance via propofol (n = 31) vs. dexmedetomidine (n = 31) |
NIHSS-positive change was higher in propofol than dexmedetomidine (p < 0.001). Focal neurologic deficits were higher in propofol than dexmedetomidine (p < 0.05). |
Rajan et al., 2016 [49][57] |
Craniotomy or transsphenoidal approach for resection of brain tumor |
Dexmedetomidine (n = 68) vs. remifentanil (n = 71) |
Dexmedetomidine was associated with significantly lower postoperative MAP (p < 0.001). Dexmedetomidine was associated with significantly longer emergence time to open eyes (p < 0.001). |
Thongrong et al., 2017 [50][58] |
Craniotomy for unspecified pathology |
Anesthetic maintenance via fentanyl (n = 30) vs. dexmedetomidine (n = 30) after propofol induction |
Dexmedetomidine infusions reduced adverse effects, with signs of effectively controlled systolic blood pressure one minute prior to skull pin insertion (p < 0.05), as well as during skull pin insertion (p < 0.01) in comparison to fentanyl. Similarly, dexmedetomidine infusions were related to reduced adverse hypertensive and hypotensive responses in patients. |
Bhardwaj et al., 2018 [51][59] |
Surgical clipping for aneurysmal subarachnoid hemorrhage |
Propofol (n = 35) vs. desflurane (n = 35) |
There was no difference in blood loss (p < 0.05), hypotension (p < 0.05), hypertension (p < 0.05), or emergence time for eyes opening (p < 0.05). |
Gracia et al., 2018 [52][60] |
Unspecified intracranial procedure |
Anesthetic induction via propofol (n = 20) vs. thiopental (n = 20) |
There was no difference in heart rate (p > 0.05). MAP was significantly higher in thiopental groups (p < 0.05). Systolic and diastolic blood pressure was significantly lower in thiopental groups (p < 0.05). |
Molina et al., 2018 [53][61] |
Craniotomy for resection of tumor |
Propofol–remifentanil (n = 105) for asleep sedation vs. conscious sedation with dexmedetomidine (n = 75) |
Patients sedated with dexmedetomidine used less opiates, antihypertensive drugs, and had a lower postoperative duration and length of stay (all p < 0.001). |
Xinyan et al., 2018 [54][62] |
Awake craniotomy for unspecified pathology |
Dexmedetomidine (n = 20), propofol (n = 20), etomidate (n = 20) |
There was no significant difference in perioperative wake up duration (p > 0.05) and postoperative emergence time (p > 0.05). The rate of adverse events was lower in dexmedetomidine than propofol and etomidate (p < 0.05). The rate of adverse events was lower in propofol than etomidate (p < 0.05). |
Khallaf et al., 2019 [55][63] |
Craniotomy for hematoma |
Anesthetic maintenance via propofol (n = 20) vs. dexmedetomidine (n = 20) |
Tachycardia, bradycardia, and hypertension occurrences were not different between the two agents. IPP and CPP changes were not different between the two agents. Hypotension occurrences were higher in the propofol group (p = 0.024). |
Preethi et al., 2021 [56][64] |
Craniotomy for hematoma |
Anesthetic maintenance via propofol (n = 45) vs. isoflurane |
Change in heart rate, systolic blood pressure, diastolic blood pressure, and MAP were not different between the two agents. Brain relaxation was higher for propofol (p < 0.05). ICP was higher for isoflurane (p = 0.01). |
Balasubramanian et al., 2021 [57][65] |
Surgical clipping/endovascular coiling for aneurysmal subarachnoid hemorrhage |
Propofol (n = 8) vs. isoflurane (n = 8) vs. sevoflurane (n = 8), vs. desflurane (n = 8) |
There was no significant difference found between anesthetic on levels of CSF caspase-3 levels. |