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ORIGINAL ARTICLE
Year : 2014  |  Volume : 62  |  Issue : 3  |  Page : 262--268

Effect of intraoperative brain protection with propofol on postoperative cognition in patients undergoing temporary clipping during intracranial aneurysm surgery

Charu Mahajan1, Rajendra Singh Chouhan1, Girija Prasad Rath1, Hari Hara Dash1, Ashish Suri2, P Sarat Chandra2, Aman Mahajan3 
1 Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India
2 Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
3 Department of Psychiatry, South Illinois University School of Medicine, Illinois, USA

Correspondence Address:
Girija Prasad Rath
Department of Neuroanaesthesiology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi - 110 029
India

Background: Cognitive dysfunction after subarachnoid hemorrhage (SAH) has been attributable to presence of subarachnoid blood, hydrocephalus (HCP), cerebral edema, vasospasm, and temporary clipping of intracranial aneurysm. Provision of neuroprotection during temporary clipping may improve postoperative cognition in such patients. Materials and Methods: Good-grade aneurysmal SAH patients undergoing temporary clipping during surgery were allocated either to group C (control) or group P (propofol). Patients in group P received propofol in titrated doses to attain a burst suppression ratio of 75 ± 5% on bispectral index (BIS) monitor. The cognitive function as assessed by Hindi-language modification of mini-mental state examination (HMSE) score was evaluated preoperatively, 24 h after surgery, and at discharge from hospital. A score of ≤23 was indicative of cognitive dysfunction. Perioperative complications, duration of intensive care unit (ICU) and hospital stay, and outcome at discharge were noted. Results: A total of 66 patients (32 and 34 in group C and P respectively) were included in the study. 97% of the patients had anterior circulation aneurysms. At 24 h after surgery, eight and 12 patients in group C and P respectively; and at discharge, five patients in each group had cognitive dysfunction. In both groups, the trend showed a decline in cognition at 24 h followed by improvement at discharge. Glasgow outcome score in both the groups was comparable (P > 0.05). Intraoperative brain bulge, postoperative vasospasm, and cerebral infarction were found to be independent risk factors for cognitive dysfunction. Conclusions: Pharmacologic neuroprotection with propofol at the time of temporary clipping during surgery for aneurysmal SAH did not offer any advantage as far as preservation of cognition is concerned.


How to cite this article:
Mahajan C, Chouhan RS, Rath GP, Dash HH, Suri A, Chandra P S, Mahajan A. Effect of intraoperative brain protection with propofol on postoperative cognition in patients undergoing temporary clipping during intracranial aneurysm surgery.Neurol India 2014;62:262-268


How to cite this URL:
Mahajan C, Chouhan RS, Rath GP, Dash HH, Suri A, Chandra P S, Mahajan A. Effect of intraoperative brain protection with propofol on postoperative cognition in patients undergoing temporary clipping during intracranial aneurysm surgery. Neurol India [serial online] 2014 [cited 2021 Mar 2 ];62:262-268
Available from: https://www.neurologyindia.com/article.asp?issn=0028-3886;year=2014;volume=62;issue=3;spage=262;epage=268;aulast=Mahajan;type=0