Total Intravenous Anesthesia Versus Volatile Anesthetic Maintenance for ACDF Surgeries- An Observational Study

Background: Anterior Cervical Discectomy and Fusion (ACDF) is a common spinal surgery aimed at relieving nerve root or spinal cord compression in the cervical spine. The choice of anesthetic technique plays a pivotal role in ensuring optimal surgical conditions, neurological monitoring, and postoperative recovery. While volatile anesthetics are traditionally used, Total Intravenous Anesthesia (TIVA) is emerging as a preferred alternative due to its favorable hemodynamic and neurophysiological profile. Objective: To compare the perioperative outcomes of TIVA versus volatile anesthesia in patients undergoing ACDF surgery, with specific focus on intubation/ extubation quality, hemodynamic stability, and intraoperative neuromonitoring compatibility. Methods: An observational study was conducted at a tertiary care institute analyzing data from 14 patients who underwent ACDF between July 2022 and March 2025. Of these, 8 received TIVA (dexmedetomidine/propofol-based) and 6 underwent volatile anesthesia. Data were collected in adherence to STROBE guidelines. Key parameters included intubation/extubation quality, Modified Observer Assessment Sedation Score (MOASS), and incidence of peri-extubation events. Results: The TIVA group exhibited smoother extubation with no incidences of coughing, tachycardia, or hypertension, although extubation was marginally delayed. No statistically significant difference was observed in MOASS between the groups. Literature review and supporting studies suggest that TIVA allows better Preservation of Motor Evoked Potentials (MEPs), improved hemodynamic stability, reduced Postoperative Nausea and Vomiting (PONV), and minimal environmental impact. Conclusion: TIVA appears to offer significant advantages over volatile anesthesia in ACDF surgeries, particularly in preserving intraoperative neurophysiological signals, providing hemodynamic stability, and facilitating safer airway management and recovery. While volatile agents remain widely used, a tailored approach considering patient risk factors and surgical demands may favour TIVA as the anesthetic of choice in select ACDF cases.