After obtaining Institutional Ethical Committee approval and written informed consent from legally acceptable representative relatives, patients with traumatic brain injury, aged from 18- 60 years old, ASA from (I-III), GCS more than 8 undergoing emergency craniotomy surgery will be selected for this prospective randomized Study.~The anesthesia will be induced with 2mcg/kg fentanyl and 2 mg/kg propofol. Muscle relaxation will be achieved with 0.5 mg/kg atracurium.~Anesthesia will be maintained with:~Group I, isoflurane (mac<1) mixed with oxygen 40% and fentanyl 1mcg/kg hourly.~Group PD, propofol infusion(100-150mcg/kg/min) and dexmedetomedine 0.3mcg/kg /h.~Parameters will be assessed Preoperative period~Ischemia modified albumin level from venous sample.~Basal Systolic blood pressure, diastolic blood pressure. Mean arterial blood pressure, oxygen saturation, heart rate.~GCS. Intraoperative period~Systolic blood pressure, diastolic blood pressure. Mean arterial blood pressure, oxygen saturation, heart rate after intubation, 5,15,30,60,90min and after extubation.~Need for resuscitation with vasoactive drugs.~Brain relaxation score at dural opening and closure.~ICP~Intraoperative blood loss.~Amount of fluid and blood transfusion. Postoperative period~Ischemia modified albumin immediately postoperatively, after 6h and after 24 hours.~Type of surgery.~Duration of surgery.~Extubation time.~Recovery scores (Ramsay sedation score and modified Alderte score).~GCS immediately postoperatively, after 6h, after 24h and after 48 hours.~Total analgesic requirement during the first 24 hours.~Need for ICU admission.~Length of ICU stay.~Complications.~28 day mortality.
In the current study the investigators intend to evaluate the mode of anesthesia on ischemia modified albumin and outcome in patients with traumatic brain injury undergoing emergency craniotomy