الفهرس 
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Abstract
After receiving institutional approval and informed consents from patients or legally representative relatives, a total of 54 male and female patients with mild or moderate TBI, aged 18-60y, (ASA) physical status I or IIE, who underwent emergency craniotomy under general anaesthesia were enrolled in this prospective randomised study at the emergency unit of Minia University Hospital between January 2021 and April 2022.
This study aimed to evaluate how the anesthetic (TIVA with dexmedetomedine versus inhalational anesthesia) can affect IMA (which is considered a biomarker of oxidative stress) and neurological outcome in emergency craniotomy procedures.
Patients enrolled into the study were divided into 2 equal groups of 27 patients in each group:-
1- group I: Received maintainance inhalational anesthesia with isoflurane (mac ≤ 1) and fentanyl 1mcg/kg hourly.
2- group P: Received maintainance intravenous anesthesia with propofol infusion (100-150 mcg/kg/min) and dexmedetomedine 0.3mcg/kg/h.
Both groups were compared with respect to:-
- Patient’s characteristics and demographic dataincluding age, sex, weight, hight, BMI, ASA status, anesthesia time and surgical time.
-Preoperative CT finding.
- Haemodynamics (systolic, diastolic, and mean arterial blood pressure and heart rate) preoperatively, immediately after intubation, after 5,15,30,60,90 minutes, immediately before extubation and after extubation.
-Recovery scores and extubation time.
-Cerebral haemodynamics and brain relaxation score.
-Surgeon satisfaction.
-Glascow coma scale : 1h postoperatively, after 6 hours, after 24 hours and after 48hours.
-Ischemia modified albumin (IMA): IMA was measured preoperatively, 1h postoperatively, after 6 hours and after 24 hours.
-correlation between IMA and GCS.
-Postoperative complications: such as convulsion, pneumocephaly, reopening, wound infection, postoperative brain ischemia and infarction.
Based on our findings, group P provides greater hemodynamic stability, lower ICP, higher surgeon satisfaction, more brain relaxation, and quicker extubation times with increased sedation. Even while postoperative IMA levels rose in both groups, the rise in group 2 was less dramatic (P). Consequences such as death, organ failure, and prolonged intensive care unit stays as well as postoperative Glasgow Coma Scale scores were similar. There was also a strong relationship between IMA and GCS across all measurements.