Clinical Observation Of Intravenous Anesthesia In Intracranial Aneurysm Patients Undergoing Interventional Spring Circle Embolization Surgery

[Objective] To compare the effects of intravenous anesthesia and inhalation anesthesia on intraoperative hemodynamic state and postoperative recovery quality in intracranial aneurysm patients undergoing interventional spring circle embolization surgery.[Methods] Sixty intracranial aneurysm ASA Ⅰ～Ⅲ patients (38males,22females) aged28～65yr undergoing general anesthesia for interventional spring circle embolization surgery were assigned randomly to two groups (n=30each):intravenous anesthesia group (T group) and inhalation anesthesia group (S group) after rapid intravenous intubation anesthesia by different maintaining method Patients were injected atropine0.5mg and phenobarbital sodium0.1g before30minitus of the operation, and then were monitored for HR, ECG, BP, the SPO2, end-tidal carbon dioxide partial pressure (PETCO2) continuously with multifunctional monitor after in the operating room. In both groups, patients was induced with intravenous injection of propofol1.5～2mg/kg, fentany13-4μg/kg, midazolam0.04-0.06mg/kg and cis-atracurium0.1～0.15mg/kg, and the throat was sprayed by2%lidocaine2ml line. After intubation, anesthesia machine was used for breath control, and was setted with respiratory parameters:VT8～10ml/kg, I:E1:2, ventilation frequency12～14times/min, to maintain SPO2more than98%carbon dioxide monitors in the connection call the end of regulation and control of PETCO2, to maintain PetCO2at35～45mmHg Anesthesia in T group was maintained with TCI of propofoi and remifentanil. TCI of propofol was seted at a target plasma concentration of2～3ug/ml with the pharmacokinetic set of Marsh et al, while the TCI of remifentanil was seted at a target effect-site concentration of4～6ng/ml with the pharmacokinetic set of Minto et al; and anesthesia in S group was maintained with2%～4%sevoflurane. The dose of both group was adjusted by intraoperative hemodynamic state suitbalely. Sevoflurane was stopped at the end of surgery and then switched with oxygen4～6L/min to discharge the anesthetic gas from the respiratory loop system. According to the needs of two groups, cis-atracurium0.03mg/kg was injected intravenous intermittently, and was not given at the15minutes before the end of the surgery.[Results] There was no significant difference in age、weight and anesthesia time between the two groups. Compared to baseline values (TO) in both groups, there was no significant difference in MAP and HR after intubation (T1),though there was a slight elevation in both groups with MAP and HR towards after intubation.(P>0.05); There was a slight rise between the two groups with MAP at the time of spring circle embolization intervention (T2) and the end of surgery (T3),but there was no significant difference compared to baseline values (TO)(P>0.05); Compared to baseline values p (TO), there was a significant increase between two groups with MAP and HR after5minutes of extubation,and also between the two groups(P<0.05).Postoperative recovery:The duration from termination of anesthetics to full recovery of spontaneous breathing, eye opening at request and tracheal extubation were similar among the two groups, while the leaving operating room time in group S was significantly higher than in group T(P<0.05). The OAAS score at extubation、 discharge from operating room and1hour after leaving the operating rome was significantly lower in group S than in group T (P<0.05). The MMSE score was also significantly lower at1hour after extubation in group S than in group T(P<0.05).There was1case of postoperative agitation,0cases of PONV in group T. In S group, there were six cases of postoperative agitation, three cases of PONV. There was no case of intraoperative awareness in both groups.[Conclusion] Intraoperative haemodynamic stability is good and comparable in both groups. TIVA of propofol and remifentanil was better to inhibit the stress response and had better postoperative recovery quality than sevoflurane anesthesia TIVA of propofol and remifentanil had lower rate of postoperative agitation、PONV and other adverse events than sevoflurane anesthesia, and was more suitable for intracranial aneurysm patients undergoing interventional spring circle embolization treatment.