Sevoflurane for interventional neuroradiology procedures is associated with more rapid early recovery than propofol.
OBJECTIVE
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.


CONCLUSIONS
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.
Castagnini
Hugo E
HE
Neuroradiology Research Institute FLENI, Buenos Aires, Argentina.
van Eijs
Frank
F
Salevsky
Frederick C
FC
Nathanson
Michael H
MH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D001784:Blood Gas Analysis; D004311:Double-Blind Method; D004621:Embolization, Therapeutic; D004809:Ephedrine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009422:Nervous System Diseases / Q000532:radiotherapy*; D015742:Propofol; D000077149:Sevoflurane; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D014662:Vasoconstrictor Agents; D000077149:Sevoflurane; D004809:Ephedrine; D015742:Propofol