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Propofol-Based Anesthesia Maintenance and/or Volatile Anesthetics during Intracranial Aneurysm Repair: A Comparative Analysis of Neurological Outcomes

Background: Volatile and intravenous anesthetics have substantial effects on physiological functions, notably influencing neurological function and susceptibility to injury. Despite the importance of the anesthetic approach, data on its relative risks or benefits during surgical clipping or endovasc...

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Autores principales: Esmaeeli, Shooka, Motayagheni, Negar, Bastos, Andres Brenes, Ogilvy, Christopher S, Thomas, Ajith J, Pollard, Richard, Buhl, Lauren K, Baker, Maxwell B, Phan, Sheshanna, Hassan, Omron, Fehnel, Corey R, Eikermann, Matthias, Shaefi, Shahzad, Nozari, Ala
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10648155/
https://www.ncbi.nlm.nih.gov/pubmed/37959418
http://dx.doi.org/10.3390/jcm12216954
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author Esmaeeli, Shooka
Motayagheni, Negar
Bastos, Andres Brenes
Ogilvy, Christopher S
Thomas, Ajith J
Pollard, Richard
Buhl, Lauren K
Baker, Maxwell B
Phan, Sheshanna
Hassan, Omron
Fehnel, Corey R
Eikermann, Matthias
Shaefi, Shahzad
Nozari, Ala
author_facet Esmaeeli, Shooka
Motayagheni, Negar
Bastos, Andres Brenes
Ogilvy, Christopher S
Thomas, Ajith J
Pollard, Richard
Buhl, Lauren K
Baker, Maxwell B
Phan, Sheshanna
Hassan, Omron
Fehnel, Corey R
Eikermann, Matthias
Shaefi, Shahzad
Nozari, Ala
author_sort Esmaeeli, Shooka
collection PubMed
description Background: Volatile and intravenous anesthetics have substantial effects on physiological functions, notably influencing neurological function and susceptibility to injury. Despite the importance of the anesthetic approach, data on its relative risks or benefits during surgical clipping or endovascular treatments for unruptured intracranial aneurysms (UIAs) remains scant. We investigated whether using volatile anesthetics alone or in combination with propofol infusion yields superior neurological outcomes following UIA obliteration. Methods: We retrospectively reviewed 1001 patients who underwent open or endovascular treatment for UIA, of whom 596 had short- and long-term neurological outcome data (modified Rankin Scale) recorded. Multivariable ordinal regression analysis was performed to examine the association between the anesthetic approach and outcomes. Results: Of 1001 patients, 765 received volatile anesthetics alone, while 236 received propofol infusion and volatile anesthetics (combined anesthetic group). Short-term neurological outcome data were available for 619 patients and long-term data for 596. No significant correlation was found between the anesthetic approach and neurologic outcomes, irrespective of the type of procedure (open craniotomy or endovascular treatment). The combined anesthetic group had a higher rate of ICU admission (p < 0.001) and longer ICU and hospital length of stay (LOS, p < 0.001). Similarly, a subgroup analysis revealed longer ICU and hospital LOS (p < 0.0001 and p < 0.001, respectively) in patients who underwent endovascular UIA obliteration under a combined anesthetic approach (n = 678). Conclusions: The addition of propofol to volatile anesthetics during UIA obliteration does not provide short- or long-term benefits to neurologic outcomes. Compared to volatile anesthetics alone, the combination of propofol and volatile anesthetics may be associated with an increased rate of ICU admission, as well as longer ICU and hospital LOS.
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spelling pubmed-106481552023-11-06 Propofol-Based Anesthesia Maintenance and/or Volatile Anesthetics during Intracranial Aneurysm Repair: A Comparative Analysis of Neurological Outcomes Esmaeeli, Shooka Motayagheni, Negar Bastos, Andres Brenes Ogilvy, Christopher S Thomas, Ajith J Pollard, Richard Buhl, Lauren K Baker, Maxwell B Phan, Sheshanna Hassan, Omron Fehnel, Corey R Eikermann, Matthias Shaefi, Shahzad Nozari, Ala J Clin Med Article Background: Volatile and intravenous anesthetics have substantial effects on physiological functions, notably influencing neurological function and susceptibility to injury. Despite the importance of the anesthetic approach, data on its relative risks or benefits during surgical clipping or endovascular treatments for unruptured intracranial aneurysms (UIAs) remains scant. We investigated whether using volatile anesthetics alone or in combination with propofol infusion yields superior neurological outcomes following UIA obliteration. Methods: We retrospectively reviewed 1001 patients who underwent open or endovascular treatment for UIA, of whom 596 had short- and long-term neurological outcome data (modified Rankin Scale) recorded. Multivariable ordinal regression analysis was performed to examine the association between the anesthetic approach and outcomes. Results: Of 1001 patients, 765 received volatile anesthetics alone, while 236 received propofol infusion and volatile anesthetics (combined anesthetic group). Short-term neurological outcome data were available for 619 patients and long-term data for 596. No significant correlation was found between the anesthetic approach and neurologic outcomes, irrespective of the type of procedure (open craniotomy or endovascular treatment). The combined anesthetic group had a higher rate of ICU admission (p < 0.001) and longer ICU and hospital length of stay (LOS, p < 0.001). Similarly, a subgroup analysis revealed longer ICU and hospital LOS (p < 0.0001 and p < 0.001, respectively) in patients who underwent endovascular UIA obliteration under a combined anesthetic approach (n = 678). Conclusions: The addition of propofol to volatile anesthetics during UIA obliteration does not provide short- or long-term benefits to neurologic outcomes. Compared to volatile anesthetics alone, the combination of propofol and volatile anesthetics may be associated with an increased rate of ICU admission, as well as longer ICU and hospital LOS. MDPI 2023-11-06 /pmc/articles/PMC10648155/ /pubmed/37959418 http://dx.doi.org/10.3390/jcm12216954 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Esmaeeli, Shooka
Motayagheni, Negar
Bastos, Andres Brenes
Ogilvy, Christopher S
Thomas, Ajith J
Pollard, Richard
Buhl, Lauren K
Baker, Maxwell B
Phan, Sheshanna
Hassan, Omron
Fehnel, Corey R
Eikermann, Matthias
Shaefi, Shahzad
Nozari, Ala
Propofol-Based Anesthesia Maintenance and/or Volatile Anesthetics during Intracranial Aneurysm Repair: A Comparative Analysis of Neurological Outcomes
title Propofol-Based Anesthesia Maintenance and/or Volatile Anesthetics during Intracranial Aneurysm Repair: A Comparative Analysis of Neurological Outcomes
title_full Propofol-Based Anesthesia Maintenance and/or Volatile Anesthetics during Intracranial Aneurysm Repair: A Comparative Analysis of Neurological Outcomes
title_fullStr Propofol-Based Anesthesia Maintenance and/or Volatile Anesthetics during Intracranial Aneurysm Repair: A Comparative Analysis of Neurological Outcomes
title_full_unstemmed Propofol-Based Anesthesia Maintenance and/or Volatile Anesthetics during Intracranial Aneurysm Repair: A Comparative Analysis of Neurological Outcomes
title_short Propofol-Based Anesthesia Maintenance and/or Volatile Anesthetics during Intracranial Aneurysm Repair: A Comparative Analysis of Neurological Outcomes
title_sort propofol-based anesthesia maintenance and/or volatile anesthetics during intracranial aneurysm repair: a comparative analysis of neurological outcomes
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10648155/
https://www.ncbi.nlm.nih.gov/pubmed/37959418
http://dx.doi.org/10.3390/jcm12216954
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