Inhalational versus intravenous anesthetic for cerebrovascular accident outcomes after surgical revascularization for adult moyamoya disease.

Abstract

Purpose: To compare the effects of inhalational anesthetics and intravenous anesthetics on the neurological function of patients with moyamoya disease (MMD) after vascular bypass surgery.

Methods: The clinical anesthesia data of patients were retrospectively collected. Patients who underwent bypass grafts with general anesthesia from January 1st, 2019, to December 31st, 2020, in Huashan Hospital affiliated with Fudan University, were selected. The primary endpoint was stroke incidence within seven days after anesthesia, and the secondary endpoints included transient neurological deficits (TNDs) and incidence of postoperative Epilepsy.

Results: We compared the data of MMD patients who received inhalational anesthetics (Sevoflurane anesthetics, n = 197, group S) and intravenous anesthetics (Propofol anesthetics, n = 219, group P). The stroke incidence in the two groups (group S vs. group P) was 6.6% vs. 5.9% (OR = 0.893; 95% CI, 0.404-1.976; p = 0.780), and the group S vs. group P of TNDs incidence was 32.5% vs. 31.1% (OR = 0.936; 95% CI, 0.619-0.1.415, p = 0.753). At discharge, anesthetics didn't affect the neurological endpoint. Intravenous anesthetics provided patients with better hemodynamics compared with inhalational anesthetics during MMD vascular bypass surgery (group S vs. group P, ARV_SBP: 6.4 vs. 5.2, p < 0.001, ARV_DBP: 3.9 vs. 3.3, p = 0.002, ARV_MBP: 4.5 vs. 3.8, p = 0.001,). There were statistical no differences in the NHISS score (S group vs. P group = 2:1, p = 0.082) at 7 days after surgery, but mRS score (S group vs. P group = 2:1, p < 0.001) at 7 days after surgery, as well as the mRS score at 6 months of follow-up (S group vs. P group = 0:0, p < 0.001), although the difference in scores was small.

Conclusion: Our data indicated that both inhalational and intravenous anesthetics had protective effects on patients who underwent MMD bypass grafts. MMD patients who received inhalational anesthetics and intravenous anesthetics had similar odds of neurological deficits. When comparing long-term clinical data, most patients experience good neurological recovery after receiving inhalation or intravenous anesthesia, when compared p₇₅ mRS score(S group vs. P group = 3:1)in 6 month indicate that intravenous anesthetics might be more suitable for patients undergoing MMD bypass grafts. During the operation hemodynamic stability in the propofol group is greater than that in the sevoflurane anesthesia group.