Comparison of the effects of inhalational and total intravenous anesthesia on quality of recovery in patients undergoing endoscopic transsphenoidal pituitary surgery: a randomized controlled trial

Do-Hyeong Kim, Kyeong Tae Min, Eui Hyun Kim, Young Seo Choi, Seung Ho Choi, Do-Hyeong Kim, Kyeong Tae Min, Eui Hyun Kim, Young Seo Choi, Seung Ho Choi

Abstract

Background: Endoscopic transsphenoidal pituitary surgery has shown promising results. However, fast and high-quality recovery after this procedure remains a challenge for neuroanesthesiologists. This study aimed to compare the quality of recovery after transsphenoidal pituitary surgery between patients who received inhalational anesthesia with sevoflurane and patients who received propofol-based total intravenous anesthesia (TIVA). Methods: Eighty-two patients undergoing transsphenoidal pituitary surgery were randomized to receive either sevoflurane inhalation with manual infusion of remifentanil (sevoflurane group) or effect-site target-controlled infusion of propofol and remifentanil (TIVA group). The primary outcome was the 40-item Quality of Recovery (QoR-40) score on postoperative day 1. The QoR-40 questionnaire was completed by patients the day before surgery and on postoperative days 1 and 2. Emergence agitation and recovery characteristics were also assessed. Results: There were no significant differences between the groups in the global QoR-40 scores on both postoperative days 1 and 2 (difference -8.7, 95% CI -18.0 to 0.7, and P = 0.204; -3.6, 95% CI -13.0 to 5.8, and P > 0.999, respectively). The time to verbal response and time to extubation were significantly shorter in the sevoflurane group than in the TIVA group (P < 0.001 and P < 0.001, respectively). However, the incidence of emergence agitation was lower in the TIVA group than in the sevoflurane group (P < 0.001). Conclusions: Both inhalational anesthesia with sevoflurane and propofol-based TIVA were appropriate anesthetic techniques for patients undergoing endoscopic transsphenoidal pituitary surgery in terms of the quality of recovery up to 2 days postoperatively. Rapid emergence was observed in the sevoflurane group, while smooth emergence was observed in the TIVA group.

Keywords: inhalational anesthesia; intravenous anesthesia; pituitary surgery; postoperative recovery.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

© The author(s).

Figures

Figure 1
Figure 1
Flowchart of patient selection. TIVA, total intravenous anesthesia.
Figure 2
Figure 2
Perioperative (A) mean arterial pressure (mmHg) and (B) heart rate (beats/min). Values are presented as mean ± standard deviation. Mean arterial pressure (PGroup × Time = 0.024) and heart rate (PGroup × Time = 0.0002) were significantly lower in the TIVA group compared with the sevoflurane group over time. TIVA, total intravenous anesthesia; T1, at baseline before anesthetic induction; T2, 10 min after the start of operation; T3, 30 min after the start of operation; T4, at cessation of main anesthetics; T5, at tracheal extubation; T6, 10 min after postanesthesia care unit admission; T7, 30 min after postanesthesia care unit admission. *P < 0.05 compared with TIVA group (Bonferroni corrected).

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