Comparison of Two Methods of Anesthesia Using Patient State Index: Propofol Versus Sevoflurane During Interventional Neuroradiology Procedure

Abstract

Background Over the past few decades, interventional neuroradiology (INR) has been a rapidly growing and evolving area of neurosurgery. Sevoflurane and propofol are both suitable anesthetics for INR procedures. While the depth of anesthesia is widely monitored, few studies have examined the patient state index (PSI) during clinical neuroanesthesia. Objectives This study aimed to investigate the differences in PSI values and in hemodynamic variables between sevoflurane anesthetic and propofol anesthetic during INR procedures. Methods We reviewed the medical charts of the patients who underwent embolization of a non-ruptured intracranial aneurysm by a single operator at a single university hospital from May 2013 to December 2014. Sixty-five patients were included and divided into two groups: S group (sevoflurane anesthesia, n = 33) vs. P group (propofol anesthesia, n = 32). The PSI values, hemodynamic variables, and use of hemodynamic drugs between two groups were analyzed. Results There were significant differences between the PSI values obtained through different perioperative stages in the two groups (P < 0.0001). During the procedure, the PSI values were significantly lower in the P group than in the S group (P = 0.000). The P group patients had a more prolonged extubation time (P = 0.005) and more phenylephrine requirement than the S group patients (P = 0.007). More anti-hypertensive drugs were administered to the patients in the S group during extubation (P = 0.0197). Conclusions The PSI can be used to detect changes in anesthetics concentration and in the depth of anesthesia during INR procedures. Although the extubation was faster under sevoflurane anesthetic, propofol anesthetic showed rather smoother recovery.

The optimal effect-site concentration of remifentanil and propofol for keeping proper anesthesia and promoting early recovery during patient state index-guided anesthesia.

“…It can collect information from both sides of the brain to detect asymmetry in the patient's electrical activity. Next, this algorithm is improved by considering individual background differences and brain responses of different patients to different anesthetics [12,31]. Finally, less impact of the shock device on the PSI value during surgery.…”

Comparison of the Jcerity Endoscoper Airway with the LMA supreme for airway management in patients undergoing cerebral aneurysm embolization: a randomized controlled non-inferiority trial

“…With the popularization of endovascular techniques, interventional embolization of unruptured cerebral aneurysms with general anesthesia under digital subtraction angiography (DSA) has become the primary treatment [ 1 – 6 ]. In order to avoid aneurysm rupture and bleeding, the maintenance of hemodynamic stability and fully sedated during the perioperative period is important factor that should be taken into account [ 7 , 8 ].…”

Comparison of bispectral index and patient state index during sevoflurane anesthesia in children: a prospective observational study

“…Although several studies have compared the effects of different monitor types in human patients such as BIS with PSI, Entropy or AAI. [13][14][15] However, many anesthesiologists have only experienced at least 2 or 3 monitors during daily practice and would like to con rm the exchangibility between the monitors.…”