Comparison of propofol alone vs propofol-phenylephrine combination for intraoperative hemodynamic stability in glioma surgery

doi:10.5662/wjm.117220

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World Journal of Methodology

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2222-0682

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Randomized Controlled Trial

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Methodol. Sep 20, 2026; 16(3): 117220
Published online Sep 20, 2026. doi: 10.5662/wjm.117220

Comparison of propofol alone vs propofol-phenylephrine combination for intraoperative hemodynamic stability in glioma surgery

Rhea Thotungal, Ashutosh Kaushal, Amit Agrawal, Anuj Jain, Vaishali Waindeskar, Rudrashish Haldar, Pfokreni Lokho

Rhea Thotungal, Ashutosh Kaushal, Anuj Jain, Vaishali Waindeskar, Pfokreni Lokho, Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal 462026, Madhya Pradesh, India

Amit Agrawal, Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal 462026, Madhya Pradesh, India

Rudrashish Haldar, Department of Anesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India

Co-first authors: Rhea Thotungal and Ashutosh Kaushal.

Author contributions: Thotungal R and Kaushal A are co-first authors and contributed equally to this work, made the most significant intellectual contributions, including designing the study, acquiring and analyzing data, and drafting the original manuscript; Thotungal R, Kaushal A, Agrawal A, Jain A, Waindeskar V, Haldar R, and Lokho P collected and analyzed the data; Kaushal A, Agrawal A, and Jain A supervised the study; Agrawal A, Jain A, Waindeskar V, Haldar R, and Lokho P reviewed and edited the original manuscript. All authors have read and approved the final version of the manuscript.

AI contribution statement: ChatGPT and Grammarly were used only for grammar correction, language refinement, and improvement of readability. The scientific content, concepts, interpretation, and all sections of the manuscript were written and developed by the authors. No section of the manuscript was fully AI-generated. AI tools were used only for language polishing and writing assistance to improve grammar and clarity. No AI tool was used for data analysis. Study design, data interpretation, conclusions, and intellectual input were performed entirely by the authors. No images or figures in the manuscript were generated by AI.

Institutional review board statement: The study was reviewed and approved by the Institutional Ethics Committee (approval No. AIIMS/BPL/IHECSR/July/22/SS/02) of the All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.

Clinical trial registration statement: This study is registered with the Clinical Trial Registry-India. The registration identification number is CTRI/2023/05/052570.

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.

Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author, drashutosh.kaushal@gmail.com.

Corresponding author: Ashutosh Kaushal, MD, DNB, PDCC, Additional Professor, Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Saket Nagar, Bhopal 462026, Madhya Pradesh, India. drashutosh.kaushal@gmail.com

Received: December 8, 2025
Revised: December 14, 2025
Accepted: March 16, 2026
Published online: September 20, 2026
Processing time: 217 Days and 3.3 Hours

Abstract

BACKGROUND

Propofol is widely used for induction in glioma surgery for its neuroprotective effects and favorable recovery profile. However, its dose-dependent hypotension is a major limitation in procedures requiring stable cerebral perfusion.

AIM

To compare the efficacy of propofol vs propofol-phenylephrine (PPE) combination in maintaining hemodynamic stability in patients undergoing glioma surgery.

METHODS

Ninety American Society of Anesthesiologists I-II patients scheduled for elective glioma surgery were randomized to receive either propofol (group P) or a PPE admixture (group PPE). Induction was performed with slow titration of the study drug until loss of verbal response and Bispectral index < 60, followed by a continuous infusion (50 μg/kg/minute) until skin closure. Hemodynamic parameters [mean arterial pressure (MAP), systolic blood pressure, diastolic blood pressure, and heart rate] were recorded at baseline, during induction, immediately after intubation, and at predefined intraoperative time points. The incidence of hypotension, vasopressor and esmolol use, and brain relaxation scores were compared.

RESULTS

Group PPE demonstrated significantly better preservation of MAP, systolic blood pressure, diastolic blood pressure, and heart rate throughout the peri-induction and intraoperative periods (P < 0.05). The mean maximum MAP reduction during induction was greater in group P compared with group PPE (19.7 mmHg vs 12.5 mmHg; P < 0.01). Hypotensive episodes were significantly more frequent in group P than in group PPE (84.4% vs 6.7%; P < 0.001). Rescue phenylephrine requirements were markedly lower in group PPE (P < 0.001). Esmolol use and brain relaxation scores were comparable between groups.

CONCLUSION

Adding phenylephrine to propofol for induction and maintenance provides superior hemodynamic stability without compromising brain relaxation in glioma surgery.

Keywords: Propofol; Phenylephrine; Hemodynamic stability; Glioma surgery; Induction of anesthesia; Neuroanesthesia; Brain relaxation

Core Tip: Propofol is widely preferred for the induction and maintenance in neuroanesthesia due to its neuroprotective properties. However, propofol frequently causes hypotension during the induction of anesthesia in neurosurgical patients, which may compromise cerebral perfusion. Therefore, combining phenylephrine with propofol significantly reduces induction-related hypotension, minimizes vasopressor requirement, and maintains stable intraoperative hemodynamics without affecting brain relaxation, offering a practical approach for neuroanesthesia in glioma surgery.