Inhalational Versus Intravenous Anesthetic Conditioning for Subarachnoid Hemorrhage-Induced Delayed Cerebral...

Area of Science:

• Neurosurgery
• Anesthesiology
• Critical Care Medicine

Background:

• Subarachnoid hemorrhage (SAH) poses risks of angiographic vasospasm and delayed cerebral ischemia (DCI).
• Inhalational anesthetics have shown potential protective effects against these complications.
• The comparative efficacy of intravenous anesthetics in preventing SAH-related vasospasm and DCI remains unclear.

Purpose of the Study:

• To compare the incidence of angiographic vasospasm and DCI in patients with SAH treated with inhalational versus intravenous anesthetics.
• To evaluate the impact of anesthetic choice on neurological outcomes at hospital discharge.

Main Methods:

• Retrospective analysis of SAH patients undergoing aneurysm repair between 2014-2018 at two academic centers.
• Comparison of outcomes between institutions primarily using inhalational versus intravenous (propofol) anesthesia.
• Statistical adjustment for confounding factors including Hunt-Hess and Fisher grades, aneurysm treatment type, and ASA status.

Main Results:

• Inhalational anesthetics were associated with significantly lower rates of angiographic vasospasm (32% vs. 52%) and DCI (21% vs. 40%) compared to intravenous anesthetics.
• Adjusted odds ratios favored inhalational anesthetics for protection against vasospasm (0.49) and DCI (0.47).
• No significant difference in good neurological discharge outcomes was observed between the two anesthetic groups (78% vs. 72%).

Conclusions:

• Inhalational anesthetics may offer significant protection against SAH-induced angiographic vasospasm and DCI.
• While site-specific factors cannot be entirely excluded, findings suggest inhalational anesthetics may be preferable for SAH patients undergoing aneurysm repair.
• Further research is needed to explore the effects of inhalational anesthetics on early brain injury and long-term neurological outcomes.