Craniotomies have a higher rate of postoperative complications than the general surgical population and adversely affects the quality of life. Moreover, patients undergoing craniotomy develop postoperative cognitive and physical deficits which makes it difficult to assess the postoperative quality of recovery.

With the advances in imaging and surgical techniques, the focus has shifted from merely eliminating pathology to ensuring maximal functional recovery as early as possible. Hence anesthetic techniques in addition to providing favorable intraoperative hemodynamics and brain relaxation must ensure a good quality of recovery to the patient as perceived by the patient.

Quality of recovery - 40 is one of the tools which helps us assess the quality of recovery postoperatively. QoR-40 questionnaire probes into 5 different aspects of health: physical comfort, physical independence, emotional state, psychological support, and pain. The validity, reliability, ease of use, and responsiveness of the QoR-40 have been confirmed in the neurosurgical population in previous studies.

                  In the practice of neuroanaesthesia, intravenous anesthesia with propofol and remifentanil has been preferred to inhalational anesthesia in terms of brain relaxation specifically in patients with raised intracranial pressure as it is known to lower subdural intracranial pressure,  provide higher cerebral perfusion pressure, and less pronounced cerebral swelling.

However, a comparison between intravenous and inhalational anesthesia for supratentorial craniotomy reveals that despite minimal differences, the short-term outcome in terms of hemodynamic stability and intraoperative brain relaxation is not affected in patients with normal intracranial pressure and both techniques are widely in use.

                  Citerio et al in their recent multicenter, randomized trial evaluating the equivalence of inhalational and intravenous anesthetic agents during craniotomy showed that the nearly postoperative recovery, intraoperative hemodynamics, brain relaxation were similar in the 2 groups and both techniques are acceptable for craniotomies.

                      Studies done in the general surgical population have demonstrated that TIVA with propofol provides a better quality of recovery as compared to Balanced General anesthesia.  However, there are no studies that have compared the quality of recovery with the 2 anesthetic techniques in the neurosurgical population.

                   We hypothesize that Balanced General Anaesthesia with Sevoflurane provides similar postoperative quality of recovery as compared to the use of TIVA with propofol and Fentanyl in patients undergoing supratentorial on the 1 st and 3 rd postoperative day (assessed by the QoR-40 questionnaire) in patients with tumors presenting for elective supratentorial craniotomy.