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

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 at comparing the incidences of EA arising from sevoflurane-based anesthesia versus 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 emergence agitation (RASS > 0) were observed in either group. However, the sevoflurane group required a significantly higher dose of ephedrine to manage intraoperative hypotension compared to the propofol group (p=0.031).Conclusion: In patients, who had undergone interventional neuroradiology, there was no difference in the incidence of emergence agitation between sevoflurane and propofol-based anesthesia. However, propofol-based TIVA may be associated with better intraoperative hemodynamic stability, as evidenced by a lower vasopressor requirement.