To Compare The Effects Of Anesthesia Induction With Sevoflurane Combined Intravenous Anesthetics Versus Total Intravenous Induction In The Treatment Of Cerebral Aneurysm Embolize Surgery

Objective:Cerebral aneurysm is a cerebrovascular disease with high mortality and morbidity.In this research,we compared the effects of anesthesia induction with sevoflurane combined intravenous anesthetics versus total intravenous anesthesia induction on cerebral aneurysm embolize surgery and explored the preferable anesthesia method for these patients.Methods:Forty patients scheduled for cerebral aneurysm embolize surgery were randomly divided into two groups:Sevoflurane group（Group S,n=20）and Control group（Group V,n=20）.Group S was treated by sevoflurane combined with intravenous induction,and Group V was treated by total intravenous induction.The vital signs（SBP,DBP,HR,SPO₂）of the two groups,as well as the level of endothelin（ET）and calcitonin gene related peptide（CGRP）and the index of cerebral oxygen supply-consumption were recorded and analyzed at the five difference time points.The five time points including the time before induction of anesthesia（T0）,5 minutes after intubation（T1）,30 minutes after intubation（T2）,at the beginning of cerebral aneurysm embolization（T3）and at the end of cerebral aneurysm embolization（T4）.We also concerned and recorded the number of using vasoactive drugs and the adverse reactions during anesthesia.Results:Compared with T0,SBP and DBP of both groups decreased after induction and the decrease in Group V was much more significantly.HR increased in both groups after induction when compared with T0.And the difference between T1 and T4 were significant for Group S.While the difference among T1,T2 and T4 were significant for Group V.When it comes to the point of T1,the increase of HR in Group S was significantly less than that in Group V.Compared with T0,ET significantly decreased after induction in both groups.CGRP in Group S was significantly increased after induction,while CGRP in Group V was decreased significantly at T1 and increased significantly at T3 and T4.Compared with group V,it was significantly lower levels of ET and higher levels of CGRP in Group S.Compared with T0,Sjv O₂ was increased after induction in two groups.There were statistical differences among T2,T3 and T4in Group S,while there were statistical differences between T3 and T4 in group V.The Ca-jvO₂ and CERO₂ of both groups decreased after induction and there were statistical difference between T0 and T4.The number of using ephedrine and nicardipine and the incidence of body movement in Group S were lower than those in Group V.There was no significant difference in SPO₂,SjvO₂,Ca-jvO₂,and CERO₂ in two groups after induction.Conclusions:Compared with the total intravenous induction,general induction with sevoflurane combined intravenous anesthetics could lead to less hemodynamic fluctuation and more stable vital signs in patients with intracranial aneurysm by intravascular embolization.Moreover,such an anesthesia method enables to maintain a stabilization with lower levels of ET and higher levels of CGRP,which significantly reduces stress reaction and the incidence of cerebral stroke during perioperative period.This will also be benefit for brain protection and further improvement for the prognosis.Accordingly,general anesthesia induction and maintenance with sevoflurane combined intravenous anesthetics is a relative idealistic method in the treatment of cerebral aneurysm embolize surgery.