Effects of Sevoflurane and Propofol on Neurological Recovery of Patients with Traumatic Brain Injury in the Early Postoperative Stage: A Retrospective Cohort Study.

To investigate the effect of propofol and sevoflurane on neurological recovery of traumatic brain injury (TBI) patients in the early postoperative stage. We analyzed the clinical data of 244 TBI patients who underwent craniotomy or decompressive craniectomy. The generalized additive mixed model (GAMM) was used to analyze the effects of propofol and sevoflurane on the Glasgow Coma Scale (GCS) on postoperative days 1, 3, and 7. Multivariate regression analysis was used to analyze the effects of the two anesthetics on the Glasgow Outcome Scale (GOS) at discharge. It showed no significant difference in GCS at admission between the propofol and the sevoflurane groups among craniotomy patients (β = 0.75, 95%CI: -0.55 to 2.05, P = 0.260). However, the elevation in GCS from baseline was 1.73 points (95%CI: -2.81 to -0.66, P = 0.002) less in the sevoflurane group than in the propofol group on postoperative day 1, 2.03 points (95%CI: -3.14 to -0.91, P < 0.001) less on day 3, and 1.31 points (95%CI: -2.43 to -0.19, P = 0.022) less on day 7. The risk of unfavorable GOS (GOS 1, 2, and 3) at discharge was higher in the sevoflurane group (OR = 4.93, 95%CI: 1.05 to 23.03, P = 0.043). No significant difference was observed among decompressive craniectomy patients in GCS and GOS. Compared to propofol, sevoflurane was associated with worse neurological recovery during the hospital stay in TBI patients undergoing craniotomy. This difference was not detected in TBI patients undergoing decompressive craniectomy.