Total Intravenous Anesthesia with Propofol for Burst Suppression in Cerebral Aneurysm Surgery

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Abstract
FORTY-TWO PATIENTS underwent cerebral aneurysm clipping at our institution in 1991, 35 with a ruptured aneurysm and 7 with an unruptured aneurysm. Preoperatively, 22 patients with a ruptured aneurysm were graded I or II according to the World Federation of Neurosurgical Societies and 21 underwent an operation 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 electroencephalogram burst suppression when temporary clipping (≥2 min) was required. Propofol doses for induction were 1.8 ± 0.1 mg/kg (mean ± standard error); for maintenance, doses were 86 ± 3.5 μg/kg per min; and for burst suppression doses were 500 μg/kg per min. After clipping, the propofol dose rate was reduced to allow early recovery and neurological examination in the operating room. In 21 patients, temporary clipping was required for a mean duration of 8.8 ± 1.3 minutes (range, 2–29); none of these patients deteriorated as compared with their preoperative neurological state. Twenty-four of the 42 patients (57%) had a Glasgow Coma Outcome Scale (GOS) score of 1, 7 patients had a GOS score of 2, 8 had a score of 3, and 3 had a score of 5. Thirty-two patients were extubated in the operating room with a mean GOS Score of 13.2 ± 0.5, and 10 were extubated later in the intensive care unit. 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.