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

[Le sévoflurane, comparé au propofol, est associé à une récupération plus rapide en neuroradiologie interventionnelle]

Hugo E. Castagnini, MD^*, Frank van Eijs, MD, Frederick C. Salevsky, MD and Michael H. Nathanson, FRCA

^* From the Neuroradiology Research Institute FLENI, Buenos Aires, Argentina;
The Saint Elisabeth Hospital, Tilburg, Netherlands;
The Montreal Neurological Hospital, Montreal, Quebec, Canada; and
The Queen’s Medical Centre, Nottingham, UK.

Address correspondence to: Dr. Michael Nathanson, Department of Anaesthesia, University Hospital, Queen’s Medical Centre, Nottingham NG7 2UH, UK. Phone: 44 115 970 9195; Fax: 44 115 978 3891; E-mail: mike.nathanson{at}nottingham.ac.uk

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 (N₂O) in oxygen (O₂), and 50 patients received propofol 4 to 10 mg•kg^–1•hr^–1 with 60% N₂O in O₂. 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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