Objectives
Subdural hematoma evacuation has been performed under general anesthesia, local anesthesia, and conscious sedation, though the adequacy of any of those techniques on its own is questionable. We aimed to compare the hemodynamic and analgesic effects of magnesium sulfate versus fentanyl as adjuncts to propofol-induced conscious sedation in patients subjected to chronic subdural hematoma (CSDH) evacuation with local infiltration.
Patients and methods
In this randomized controlled trial, we included adult patients with CSDH undergoing evacuation through burr-hole surgery. All patients received continuous infusion of propofol. Patients in the magnesium group (=16) received magnesium sulfate (loading dose of 50 mg/kg and then continuous infusion at 15 mg/kg/h). Patients in the fentanyl group (=16) received fentanyl (loading dose: 1 μg/kg and then continuous infusion at 0.5 μg/kg/h). The primary outcome was intraoperative systolic blood pressure. The secondary outcomes included incidence of hypotension and bradycardia, the total dose of propofol, time to awake, and the incidence of postoperative nausea and vomiting.
Results
A total of 32 patients were analyzed. The average intraoperative systolic blood pressure was better maintained in the magnesium group. Furthermore, the incidence of hypotension, nausea, and vomiting was lower in the magnesium group. The time to awake was shorter in the magnesium group. The incidence of bradycardia, total propofol requirements, time to first rescue analgesia, and surgeon satisfaction were comparable between groups.
Conclusion
Magnesium sulfate was associated with a better hemodynamic profile and less incidence of nausea and vomiting in comparison with fentanyl when combined with propofol for conscious sedation during CSDH evacuation. It produced an anesthetic-sparing effect comparable to fentanyl.