Effects of Sevoflurane and Propofol on Neurological Recovery of Traumatic Brain Injury Patients in the Early Postoperative Stage: A Retrospective Cohort Study

Bei Wu; Wan-Qing Song; Jin-Qian Dong; Hong-Li Yue; Yu Lu; Yun Yu; Shu-Yu Hao; Bai-Yun Liu; Wei-Hua Cui

doi:10.24920/004188

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Effects of Sevoflurane and Propofol on Neurological Recovery of Traumatic Brain Injury Patients in the Early Postoperative Stage: A Retrospective Cohort Study

Chinese Medical Sciences Journal Vol. 38, Issue 2, Pages: 97-108(2023)

Original article | Updated：2024-06-12

- Effects of Sevoflurane and Propofol on Neurological Recovery of Traumatic Brain Injury Patients in the Early Postoperative Stage: A Retrospective Cohort Study
- Affiliations：
  
  1. 1Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
  2. 2Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- Author bio：
  
  *weihuacui@ccmu.edu.cn
- Funds：
- DOI：10.24920/004188
  CLC：
- Received：03 November 2022，
  
  Accepted：2023-01-19，
  
  Published Online：06 February 2023，
  
  Published：30 June 2023
- Accepted：
Scan QR Code
Bei Wu, Wan-Qing Song, Jin-Qian Dong, et al. Effects of Sevoflurane and Propofol on Neurological Recovery of Traumatic Brain Injury Patients in the Early Postoperative Stage: A Retrospective Cohort Study[J]. Chinese medical sciences journal, 2023, 38(2): 97-108.
DOI：

Bei Wu, Wan-Qing Song, Jin-Qian Dong, et al. Effects of Sevoflurane and Propofol on Neurological Recovery of Traumatic Brain Injury Patients in the Early Postoperative Stage: A Retrospective Cohort Study[J]. Chinese medical sciences journal, 2023, 38(2): 97-108. DOI： 10.24920/004188.

摘要

目的

本研究旨在探讨丙泊酚和七氟醚对创伤性颅脑外伤（traumatic brain injury，TBI）患者术后早期神经功能恢复的影响。

方法

我们回顾性分析了244例行去骨瓣或非去骨瓣减压手术的TBI患者的临床资料。应用广义相加混合模型比较丙泊酚和七氟醚对患者术后第1、3、7天格拉斯哥昏迷（Glasgow Coma Scale，GCS）评分影响的差异。采用多元回归分析比较两种麻醉药对患者出院时格拉斯哥结局量表（GOS）评分影响的差异。

结果

丙泊酚组与七氟醚组患者入院时GCS评分的差异无统计学意义（

= 0.75，95%

：-0.55~2.05，

= 0.260）。在接受非去骨瓣减压手术的患者中，七氟醚组术后GCS评分较基线水平升高的值显著低于丙泊酚组：在术后第1天低1.73（95%CI：-2.81~-0.66，

= 0.002），在术后第3天低2.03（95%CI：-3.14~-0.91，

0.001），在术后第7天低1.31（95%CI：-2.43~-0.19，

= 0.022）；在出院时，七氟醚组患者发生不良GOS评分（评分为1、2、3分）的风险较高（

= 4.93，95%

：1.05~23.03，

= 0.043）。在接受去骨瓣减压手术的患者中，两组GCS与GOS评分的差异无统计学意义。

结论

在接受非去骨瓣减压手术的TBI患者中，与丙泊酚相比，七氟醚可能与患者住院期间神经功能恢复较差相关；而在接受去骨瓣减压手术的TBI患者中，两者对患者神经功能恢复影响的差异不明显。

Abstract

Objective

To investigate the effects of propof

ol and sevoflurane on neurological recovery of traumatic brain injury (TBI) patients in the early postoperative stage.

Methods

We retrospectively analyzed the clinical data of TBI patients who underwent craniotomy or decompressive craniectomy. Generalized additive mixed model (GAMM) was used to analyze effects of propofol and sevoflurane on Glasgow Coma Scale (GCS) on postoperative days 1

and 7. Multivariate regression analysis was used to analyze effects of the two anesthetics on Glasgow Outcome Scale (GOS) at discharge.

Results

A total of 340 TBI patients were enrolled in this study. There were 110 TBI patients who underwent craniotomy including 75 in the propofol group and 35 in the sevoflurane group

and 134 patients who underwent decompressive craniectomy including 63 in the propofol group and 71 in the sevoflurane group. It showed no significant difference in GCS at admission between the propofol and the sevoflurane groups among craniotomy patients (

= 0.75

95%

: -0.55 to 2.05

= 0.260). However

elevation in GCS from baseline was 1.73 points (95%

: -2.81 to -0.66

= 0.002) less in the sevoflurane group than that in the propofol group on postoperative day 1

2.03 points (95%

: -3.14 to -0.91

0.001) less on day 3

and 1.31 points (95%

: -2.43 to -0.19

= 0.022) less on day 7. The risk of unfavorable GOS (GOS 1

and 3) at discharge was higher in the sevoflurane group (

= 4.93

95%

: 1.05 to 23.03

= 0.043). No significant difference was observed among two-group decompressive craniectomy patients in GCS and GOS.

Conclusions

Compared to propofol

sevoflurane was associated with worse neurological recovery during the hospital stay in TBI patients undergoing craniotomy. This difference was

not detected in TBI patients undergoing decompressive craniectomy.

关键词

Keywords

references

Dewan MC , Rattani A , Gupta S , et al . Estimating the global incidence of traumatic brain injury . J Neurosurg 2018 ; 130 ( 4 ): 1 - 18 . doi: 10.3171/2017.10.JNS17352 https://dx.doi.org/10.3171/2017.10.JNS17352 . DOI: 10.3171/2017.10.JNS17352 http://doi.org/10.3171/2017.10.JNS17352

Kaisti KK , Metsahonkala L , Teras M , et al . Effects of surgical levels of propofol and sevoflurane anesthesia on cerebral blood flow in healthy subjects studied with positron emission tomography . Anesthesiology 2002 ; 96 ( 6 ): 1358 - 70 . doi: 10.1097/00000542-200206000-00015 https://dx.doi.org/10.1097/00000542-200206000-00015 . DOI: 10.1097/00000542-200206000-00015 http://doi.org/10.1097/00000542-200206000-00015

Liao R , Li J , Liu J . Volatile induction/maintenance of anaesthesia with sevoflurane increases jugular venous oxygen saturation and lumbar cerebrospinal fluid pressure in patients undergoing craniotomy . Eur J Anaesthesiol 2010 ; 27 ( 4 ): 369 - 76 . doi: 10.1097/EJA.0b013e32832edc70 https://dx.doi.org/10.1097/EJA.0b013e32832edc70 . DOI: 10.1097/EJA.0b013e32832edc70 http://doi.org/10.1097/EJA.0b013e32832edc70

Hawryluk GW , Manley GT . Classification of traumatic brain injury: past, present, and future . Handb Clin Neurol 2015 ; 127 : 15 - 21 . doi: 10.1016/B978-0-444-52892-6.00002-7 https://dx.doi.org/10.1016/B978-0-444-52892-6.00002-7 . DOI: 10.1016/B978-0-444-52892-6.00002-7 http://doi.org/10.1016/B978-0-444-52892-6.00002-7

Rimel RW , Giordani B , Barth JT , et al . Moderate head injury: completing the clinical spectrum of brain trauma . Neurosurgery 1982 ; 11 ( 3 ): 344 - 51 . doi: 10.1227/00006123-198209000-00002 https://dx.doi.org/10.1227/00006123-198209000-00002 . DOI: 10.1227/00006123-198209000-00002 http://doi.org/10.1227/00006123-198209000-00002

McMillan T , Wilson L , Ponsford J , et al . The Glasgow Outcome Scale— 40 years of application and refinement . Nat Rev Neurol 2016 ; 12 ( 8 ): 477 - 85 . doi: 10.1038/nrneurol.2016.89 https://dx.doi.org/10.1038/nrneurol.2016.89 . DOI: 10.1038/nrneurol.2016.89 http://doi.org/10.1038/nrneurol.2016.89

Oertel M , Kelly DF , McArthur D , et al . Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury . J Neurosurg 2002 ; 96 ( 1 ): 109 - 16 . doi: 10.3171/jns.2002.96.1.0109 https://dx.doi.org/10.3171/jns.2002.96.1.0109 . DOI: 10.3171/jns.2002.96.1.0109 http://doi.org/10.3171/jns.2002.96.1.0109

Jost JN . Primary decompressive craniectomy after traumatic brain injury: a literature review . Cureus 2022 ; 14 ( 10 ): e29894 . doi: 10.7759/cureus.29894 https://dx.doi.org/10.7759/cureus.29894 . DOI : 10.7759/cureus.29894 http://doi.org/10.7759/cureus.29894

Yang C , Zhang JR , Zhu G . Effects of primary decompressive craniectomy on the outcomes of serious traumatic brain injury with mass lesions, and independent predictors of operation decision . World Neurosurg 2021 ; 148 : e396 -e405. doi: 10.1016/j.wneu.2020.12.158 https://dx.doi.org/10.1016/j.wneu.2020.12.158 . DOI: 10.1016/j.wneu.2020.12.158 http://doi.org/10.1016/j.wneu.2020.12.158

Kim H , Suh SJ , Kang HJ , et al . Predictable values of decompressive craniectomy in patients with acute subdural hematoma: comparison between decompressive craniectomy after craniotomy group and craniotomy only group . Korean J Neurotrauma 2018 ; 14 ( 1 ): 14 - 9 . doi: 10.13004/kjnt.2018.14.1.14 https://dx.doi.org/10.13004/kjnt.2018.14.1.14 . DOI: 10.13004/kjnt.2018.14.1.14 http://doi.org/10.13004/kjnt.2018.14.1.14

Hutchinson PJ , Kolias AG , Tajsic T , et al . Consensus statement from the International Consensus Meeting on the role of decompressive craniectomy in the management of traumatic brain injury: consensus statement . Acta Neurochir (Wien) 2019 ; 161 ( 7 ): 1261 - 74 . doi: 10.1007/s00701-019-03936-y https://dx.doi.org/10.1007/s00701-019-03936-y . DOI: 10.1007/s00701-019-03936-y http://doi.org/10.1007/s00701-019-03936-y

Tapper J , Skrifvars MB , Kivisaari R , et al . Primary decompressive craniectomy is associated with worse neurological outcome in patients with traumatic brain injury requiring acute surgery . Surg Neurol Int 2017 ; 8 : 141 . doi: 10.4103/sni.sni_453_16 https://dx.doi.org/10.4103/sni.sni_453_16 . DOI: 10.4103/sni.sni_453_16 http://doi.org/10.4103/sni.sni_453_16

Phan K , Moore JM , Griessenauer C , et al . Craniotomy versus decompressive craniectomy for acute subdural hematoma: systematic review and meta-analysis . World Neurosurg 2017 ; 101 : 677 - 85 .e672. doi: 10.1016/j.wneu.2017.03.024 https://dx.doi.org/10.1016/j.wneu.2017.03.024 . DOI: 10.1016/j.wneu.2017.03.024 http://doi.org/10.1016/j.wneu.2017.03.024

Mosenthal AC , Lavery RF , Addis M , et al . Isolated traumatic brain injury: age is an independent predictor of mortality and early outcome . J Trauma 2002 ; 52 ( 5 ): 907 - 11 . doi: 10.1097/00005373-200205000-00015 https://dx.doi.org/10.1097/00005373-200205000-00015 . DOI: 10.1097/00005373-200205000-00015 http://doi.org/10.1097/00005373-200205000-00015

Lieberman JD , Pasquale MD , Garcia R , et al . Use of admission Glasgow Coma Score, pupil size, and pupil reactivity to determine outcome for trauma patients . J Trauma 2003 ; 55 ( 3 ):437-42; discussion 442 - 3 . doi: 10.1097/01.TA.0000081882.79587.17 https://dx.doi.org/10.1097/01.TA.0000081882.79587.17 . DOI: 10.1097/01.TA.0000081882.79587.17 http://doi.org/10.1097/01.TA.0000081882.79587.17

Gutowski P , Meier U , Rohde V , et al . Clinical outcome of epidural hematoma treated surgically in the era of modern resuscitation and trauma care . World Neurosurg 2018 ; 118 : e166 -e74. doi: 10.1016/j.wneu.2018.06.147 https://dx.doi.org/10.1016/j.wneu.2018.06.147 . DOI: 10.1016/j.wneu.2018.06.147 http://doi.org/10.1016/j.wneu.2018.06.147 https://linkinghub.elsevier.com/retrieve/pii/S1878875018313639 https://linkinghub.elsevier.com/retrieve/pii/S1878875018313639

Komurcu O , Dost B , Ozdemir E , et al . Red blood cell transfusion and hemoglobin level on neurological outcome in the first 24 hours of traumatic brain injury . Am J Emerg Med 2022 ; 59 : 74 - 8 . doi: 10.1016/j.ajem.2022.06.058 https://dx.doi.org/10.1016/j.ajem.2022.06.058 . DOI: 10.1016/j.ajem.2022.06.058 http://doi.org/10.1016/j.ajem.2022.06.058

Maas AI , Hukkelhoven CW , Marshall LF , et al . Prediction of outcome in traumatic brain injury with computed tomographic characteristics: a comparison between the computed tomographic classification and combinations of computed tomographic predictors . Neurosurgery 2005 ; 57 ( 6 ):1173-82; discussion 1173 - 82 . doi: 10.1227/01.neu.0000186013.63046.6b https://dx.doi.org/10.1227/01.neu.0000186013.63046.6b . DOI: 10.1227/01.neu.0000186013.63046.6b http://doi.org/10.1227/01.neu.0000186013.63046.6b

Alali AS , Temkin N , Barber J , et al . A clinical decision rule to predict intracranial hypertension in severe traumatic brain injury . J Neurosurg 2018 ; 131 ( 2 ): 612 - 9 . doi: 10.3171/2018.4.JNS173166 https://dx.doi.org/10.3171/2018.4.JNS173166 . DOI: 10.3171/2018.4.JNS173166 http://doi.org/10.3171/2018.4.JNS173166

Maas AI , Steyerberg EW , Butcher I , et al . Prognostic value of computerized tomography scan characteristics in traumatic brain injury: results from the IMPACT study . J Neurotrauma 2007 ; 24 ( 2 ): 303 - 14 . doi: 10.1089/neu.2006.0033 https://dx.doi.org/10.1089/neu.2006.0033 . DOI: 10.1089/neu.2006.0033 http://doi.org/10.1089/neu.2006.0033

Collaborators MCT , Perel P , Arango M , et al . Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients . BMJ 2008 ; 336 ( 7641 ): 425 - 9 . doi: 10.1136/bmj.39461.643438.25 https://dx.doi.org/10.1136/bmj.39461.643438.25 . DOI: 10.1136/bmj.39461.643438.25 http://doi.org/10.1136/bmj.39461.643438.25

Maas AI , Marmarou A , Murray GD , et al . Prognosis and clinical trial design in traumatic brain injury: the IMPACT study . J Neurotrauma 2007 ; 24 ( 2 ): 232 - 8 . doi: 10.1089/neu.2006.0024 https://dx.doi.org/10.1089/neu.2006.0024 . DOI: 10.1089/neu.2006.0024 http://doi.org/10.1089/neu.2006.0024

Hagiwara A , Kushimoto S , Kato H , et al . Can early aggressive administration of fresh frozen plasma improve outcomes in patients with severe blunt trauma?—A report by the Japanese Association for the Surgery of Trauma . Shock 2016 ; 45 ( 5 ): 495 - 501 . doi: 10.1097/SHK.0000000000000536 https://dx.doi.org/10.1097/SHK.0000000000000536 . DOI: 10.1097/SHK.0000000000000536 http://doi.org/10.1097/SHK.0000000000000536

Haltmeier T , Benjamin E , Gruen JP , et al . Decreased mortality in patients with isolated severe blunt traumatic brain injury receiving higher plasma to packed red blood cells transfusion ratios . Injury 2018 ; 49 ( 1 ): 62 - 6 . doi: 10.1016/j.injury.2017.07.035 https://dx.doi.org/10.1016/j.injury.2017.07.035 . DOI: 10.1016/j.injury.2017.07.035 http://doi.org/10.1016/j.injury.2017.07.035

Zhao Z , Wang D , Jia Y , et al . Analysis of the association of fluid balance and short-term outcome in traumatic brain injury . J Neurol Sci 2016 ; 364 : 12 - 8 . doi: 10.1016/j.jns.2016.03.007 https://dx.doi.org/10.1016/j.jns.2016.03.007 . DOI: 10.1016/j.jns.2016.03.007 http://doi.org/10.1016/j.jns.2016.03.007

Alnemari AM , Krafcik BM , Mansour TR , et al . A comparison of pharmacologic therapeutic agents used for the reduction of intracranial pressure after traumatic brain injury . World Neurosurg 2017 ; 106 : 509 - 28 . doi: 10.1016/j.wneu.2017.07.009 https://dx.doi.org/10.1016/j.wneu.2017.07.009 . DOI: S1878-8750(17)31108-7 http://doi.org/S1878-8750(17)31108-7

Ma J , Xiao W , Wang J , Wu J , et al . Propofol inhibits NLRP 3 inflammasome and attenuates blast-induced traumatic brain injury in rats . Inflammation 2016 ; 39 ( 6 ): 2094 - 103 . doi: 10.1007/s10753-016-0446-8 https://dx.doi.org/10.1007/s10753-016-0446-8 . DOI: 10.1007/s10753-016-0446-8 http://doi.org/10.1007/s10753-016-0446-8

Liu F , Chen MR , Liu J , et al . Propofol administration improves neurological function associated with inhibition of pro-inflammatory cytokines in adult rats after traumatic brain injury . Neuropeptides 2016 ; 58 : 1 - 6 . doi: 10.1016/j.npep.2016.03.004 https://dx.doi.org/10.1016/j.npep.2016.03.004 . DOI: 10.1016/j.npep.2016.03.004 http://doi.org/10.1016/j.npep.2016.03.004

Liu S , Sun JY , Ren LP , et al . Propofol attenuates intermittent hypoxia induced up-regulation of proinflammatory cytokines in microglia through inhibiting the activation of NF-Bkappa/p 38 MAPK signalling . Folia Neuropathol 2017 ; 55 ( 2 ): 124 - 31 . doi: 10.5114/fn.2017.68579 https://dx.doi.org/10.5114/fn.2017.68579 . DOI: 10.5114/fn.2017.68579 http://doi.org/10.5114/fn.2017.68579

Luo T , Wu J , Kabadi SV , et al . Propofol limits microglial activation after experimental brain trauma through inhibition of nicotinamide adenine dinucleotide phosphate oxidase . Anesthesiology 2013 ; 119 ( 6 ): 1370 - 88 . doi: 10.1097/ALN.0000000000000020 https://dx.doi.org/10.1097/ALN.0000000000000020 . DOI: 10.1097/ALN.0000000000000020 http://doi.org/10.1097/ALN.0000000000000020

Yang WC , Zhou LJ , Zhang R , et al . Effects of propofol and sevoflurane on aquaporin-4 and aquaporin-9 expression in patients performed gliomas resection . Brain Res 2015 ; 1622: 1 - 6 . doi: 10.1016/j.brainres.2015.05.042 https://dx.doi.org/10.1016/j.brainres.2015.05.042 . DOI: 10.1016/j.brainres.2015.05.042 http://doi.org/10.1016/j.brainres.2015.05.042

Ding Z , Zhang J , Xu J , et al . Propofol administration modulates AQP-4 expression and brain edema after traumatic brain injury . Cell Biochem Biophys 2013 ; 67 ( 2 ): 615 - 22 . doi: 10.1007/s12013-013-9549-0 https://dx.doi.org/10.1007/s12013-013-9549-0 . DOI: 10.1007/s12013-013-9549-0 http://doi.org/10.1007/s12013-013-9549-0

He H , Liu W , Zhou Y , et al . Sevoflurane post-conditioning attenuates traumatic brain injury-induced neuronal apoptosis by promoting autophagy via the PI3K/AKT signaling pathway . Drug Des Devel Ther 2018 ; 12 : 629 - 38 . doi: 10.2147/DDDT.S158313 https://dx.doi.org/10.2147/DDDT.S158313 . DOI: 10.2147/DDDT.S158313 http://doi.org/10.2147/DDDT.S158313 https://www.dovepress.com/drug-design-development-and-therapy-journal https://www.dovepress.com/drug-design-development-and-therapy-journal

Zhang L , Zhang J , Yang L , et al . Isoflurane and sevoflurane increase interleukin-6 levels through the nuclear factor-kappa B pathway in neuroglioma cells . Br J Anaesth 2013 ; 110 Suppl 1( Suppl 1 ): i82 - 91 . doi: 10.1093/bja/aet115 https://dx.doi.org/10.1093/bja/aet115 . DOI: 10.1093/bja/aet115 http://doi.org/10.1093/bja/aet115 https://linkinghub.elsevier.com/retrieve/pii/S0007091217326521 https://linkinghub.elsevier.com/retrieve/pii/S0007091217326521

Hassan W , Nasir YM , Zaini RHM , et al . Target-controlled infusion propofol versus sevoflurane anaesthesia for emergency traumatic brain surgery: comparison of the outcomes . Malays J Med Sci 2017 ; 24 ( 5 ): 73 - 82 . doi: 10.21315/mjms2017.24.5.8 https://dx.doi.org/10.21315/mjms2017.24.5.8 . DOI: 10.21315/mjms2017.24.5.8 http://doi.org/10.21315/mjms2017.24.5.8

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