Total Intravenous Anesthesia Using Propofol for Burst Suppression in Cerebral Aneurysm Surgery: Preliminary Report of 44 Cases

Summary

Forty-four patients underwent cerebral aneurysm clipping at our institution in 1991, 37 with a ruptured and 7 with an unruptured aneurysm. Preoperatively 30 patients with a ruptured aneurysm were graded I–II according to the World Federation of Neurosurgical Societies (WFNS) and 27 were operated on the first day. All underwent a standard cerebral protective general anesthesia, combining propofol with fentanyl, arterial normotension (mild hypertension with volume loading and/or dopamine during temporary clipping and once the aneurysm was secured), normocarbia or slight hypocarbia, brain relaxation with lumbar drainage, mannitol and propofol, and EEG burst suppression when temporary clipping (2 min) was required. After clipping, the propofol dose-rate was reduced to allow early recovery and neurological examination in the operating room. In 22 patients temporary clipping was required for a mean duration (± SEM) of 7.2 ± 0.6 min (range 2–29); none of these patients deteriorated as compared to their preoperative neurological state. Twenty-six out of the 44 patients had a Glasgow Coma Outcome Score (GOS) of 1, 7 patients had a GOS of 2, 8 of 3, and 3 of 5.34 patients were extubated in the operating room and 10 later in the ICU. In conclusion, a propofol technique for maintenance and burst suppression in cerebral aneurysm clipping procedures, together with arterial hypertension when indicated, seems to be a worthy alternative to the classical isoflurane-hypertensive technique.