Effect of total intravenous and inhalational anesthesia on cerebral oxygenation, metabolism, and neurological outcomes among patients with moyamoya disease during revascularization surgeries: A comparative analysis

Abstract: INTRODUCTION: Moyamoya disease (MMD) is a cerebrovascular disorder wherein progressive occlusion of the intracranial arteries leads to cerebral ischemia. This study aimed to compare the influence of anesthesia techniques, namely, inhalational anesthesia (INHA) and total intravenous anesthesia (TIVA), on intraoperative cerebral oxygenation and outcomes following combined direct and indirect revascularization for MMD. MATERIALS AND METHODS: This retrospective observational study was conducted at a tertiary care center, where we analyzed data from 73 patients who underwent combined revascularization for MMD between December 2007 and November 2023. Patients with incomplete records or deviations from standard anesthesia protocols were excluded. Collected data included demographics, clinical presentation, anesthetic and surgical details, intraoperative parameters (hemodynamics, jugular oximetry, cerebral oxygenation, and blood gases), and postoperative outcomes (neurological deficits, complications, and modified Rankin scale [mRS] scores). Statistical analyses compared TIVA ( n = 25) and INHA ( n = 22) groups using appropriate tests for continuous and categorical variables. RESULTS: The patient demographic and clinical parameters, such as age, gender, preoperative neurological status, and surgical parameters, were similar between groups. The TIVA group demonstrated low arteriovenous oxygen difference with high jugular venous oxygen saturation along with significantly lower cerebral metabolic rate of oxygen, cerebral oxygen extraction, and lactate-oxygen index compared to the INHA group ( P < 0.05). No differences were observed with regard to postoperative neurological events or mRS scores at discharge and 3 months ( P > 0.005). CONCLUSION: TIVA may enhance cerebral oxygenation and metabolic parameters during MMD revascularization, likely due to propofol’s neuroprotective effects. However, these benefits did not translate into significant improvements in postoperative neurological outcomes or hospital stay.