The Effects of Sevoflurane Versus Total Intravenous Anesthesia on Emergence Agitation After Interventional Neuroradiology: A Prospective Randomized Controlled Trial

Abstract

Background: Interventional neuroradiology (INR) is a minimally invasive procedure that is often performed under general anesthesia. A potential complication, emergence agitation (EA), can hinder immediate and accurate postoperative neurological assessments. Sevoflurane and propofol are common anesthetics used for these procedures. This study aimed to compare the incidence of EA between sevoflurane-based anesthesia and propofol-based total intravenous anesthesia (TIVA). Methods: Eighty patients scheduled for INR under general anesthesia were randomly allocated into two groups. The sevoflurane group (n = 40) received induction with propofol, fentanyl, and cisatracurium, followed by sevoflurane for maintenance. The propofol group (n = 40) received a target-controlled infusion (TCI) of propofol for both induction and maintenance. Anesthetic depth was maintained at a Bispectral Index (BIS) of 40–60 in both groups. The primary outcome was the incidence of EA, which was assessed using the Richmond Agitation-Sedation Scale (RASS). Secondary outcomes consisted of time to recovery, pain scores, postoperative nausea and vomiting, and hemodynamic instability. Results: No incidences of EA (RASS > 0) were observed in either group. However, the sevoflurane group required a significantly higher ephedrine dose to manage intraoperative hypotension than the propofol group (p = 0.031). Conclusion: In patients undergoing INR, the incidence of EA was zero in both groups, which precludes a definitive comparison of anesthetic efficacy for this outcome. However, propofol-based TIVA demonstrated significantly better intraoperative hemodynamic stability, as evidenced by a substantially lower ephedrine requirement. Trial Registration: Thai Clinical Trials Registry: TCTR20210104002.