Neuroprotective effects of thiopental, propofol, and etomidate

In selecting an anesthetic agent to be used for neurosurgical procedures, the anesthesia provider must consider the agent's effects on intracranial pressure (ICP), cerebral blood flow (CBF), and cerebral metabolic rate of oxygen consumption (CMRO2). The anesthetic of choice for neurosurgical procedures for many decades has been thiopental. It meets the strict requirements for neurosurgical procedures because it protects the brain from ischemia and herniation by lowering ICP through decreases in CBF and CMRO However, new drugs, including etomidate and propofol, have been introduced that offer anesthesia providers comparable neuroprotective actions plus other positive attributes. The purpose of this course is to review current and benchmark literature on thiopental, propofol, and etomidate to compare researchers' reports of the effects on ICP, CMRO2, and CBF Literature was gathered using computer assistance to search PubMed, the Cumulative Index of Nursing and Allied Health Literature, and the World Wide Web. The literature showed that all 3 anesthetic agents provide favorable neurological protection. Each drug has some undesirable side effects. Knowledge of these side effects and the patient's medical and surgical history can help CRNAs determine the most suitable anesthetic in specific situations.