Total intravenous anaesthesia versus inhaled anaesthetics in neurosurgery
Introduction: The way neurosurgery has evolved has led to increased emphasis on anaesthetic techniques aimed at improving patient well-being. In the United States alone, the number of neurosurgeries has increased significantly, with growth reflected in approximately 12,000 spine procedures per year and another 2700 different neurosurgical procedures per year. For anaesthetists, this means that they are faced more frequently with the need to select the most adequate neuroanaesthesia technique for each patient.
Objectives: The purpose of this review is to analyze the role of inhaled and intravenous anaesthetics in neurosurgical procedures.
Methodology: A search was conducted in PubMed using the terms TIVA, inhaled anaesthetics, neurosurgery and spine surgery.
Results: The articles included in the review show that the adequate anaesthetic technique, besides ensuring a rapid onset of action, contributes to ease of titration with minimum effect on systemic and cerebral haemodynamics; it must enable intraoperative neurophysiological monitoring and rapid emergence, in order to allow early assessment of the patient’s neurological function and improved outcome.
Conclusions: In recent years, the question regarding the use of inhaled vs. intravenous anaesthetics in neurosurgery has given rise to several research studies. Although TIVA is the technique used most frequently, inhaled anaesthetics have also been shown to be safe, titratable, and to provide for adequate intraoperative monitoring and cerebral haemodynamic stability. In patients with normal intracranial compliance, inhaled agents (IA) are a good alternative to TIVA, especially in places where hospital resources are limited.
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