A patient is undergoing craniotomy for a supratentorial glioma. Intraoperatively, the ICP rises to 28 mmHg. Which of the following interventions reduces ICP by decreasing cerebral metabolic rate of oxygen (CMRO2) AND causing cerebral vasoconstriction?
- A Mannitol 0.5 g/kg IV bolus
- B Hyperventilation to PaCO2 30 mmHg
- C Propofol infusion (total intravenous anaesthesia) ✓
- D Furosemide 20 mg IV
Correct answer: C. Propofol infusion (total intravenous anaesthesia)
Explanation
Propofol reduces both CMRO2 (by ~36%) and produces cerebral vasoconstriction secondary to reduced metabolic demand, thereby lowering CBF and ICP. It also suppresses seizure activity and provides dose-dependent EEG burst suppression, making it ideal for neuroanaesthesia. Mannitol reduces ICP through osmotic dehydration of brain parenchyma and by reducing blood viscosity, but does not reduce CMRO2. Hyperventilation reduces ICP via vasoconstriction but does not reduce CMRO2. Furosemide reduces CSF production but has no direct CMRO2 effect.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.