Sevoflurane for interventional neuroradiology procedures is associated with more
rapid early recovery than propofol.
Author(s): Castagnini HE(1), van Eijs F, Salevsky FC, Nathanson MH.
Affiliation(s): Author information:
(1)Neuroradiology Research Institute FLENI, Buenos Aires, Argentina.
Publication date & source: 2004, Can J Anaesth. , 51(5):486-91
PURPOSE: Sevoflurane and propofol are both suitable for neuroanesthesia but have
not previously been compared as maintenance agents for long duration (one to five
hours) procedures.
METHODS: Using a multicentre international study protocol, 103 patients were
randomized to receive either sevoflurane or propofol for maintenance of
anesthesia during interventional neuroradiology procedures. After a standardized
induction of anesthesia with propofol, 53 patients received sevoflurane 1 to 3%
with 60% nitrous oxide (N(2)O) in oxygen (O(2)), and 50 patients received
propofol 4 to 10 mg x kg(-1) x hr(-1) with 60% N(2)O in O(2). Maintenance agents
were titrated against systemic arterial blood pressure (baseline mean arterial
pressure +/- 20%). Recovery times, changes in sedation, pain, nausea and vomiting
and psychomotor function during recovery and use of rescue medication were
recorded.
RESULTS: The group receiving sevoflurane had a more rapid recovery to spontaneous
ventilation, extubation, eye opening and orientation compared to the group
receiving propofol (3 vs 4 min, P = 0.01; 5 vs 6 min, P = 0.015; 7 vs 10 min, P <
0.001; 13 vs 17 min, P = 0.028; respectively). Sedation, pain, nausea and
vomiting, and psychomotor function scores were similar in the two groups. Use of
opioid boluses and vasopressors were similar.
CONCLUSION: The use of sevoflurane for maintenance of anesthesia for prolonged
neuroradiological procedures is associated with more rapid early recovery than
propofol and is associated with similar side effects. Sevoflurane and propofol
can both be recommended for these procedures. The clinical benefit of the more
rapid recovery with sevoflurane is unknown.
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