Propofol vs. sevoflurane anesthesia on the postoperative quality of recovery in patients with moyamoya disease: a randomized controlled trial

Abstract Background Patients with moyamoya disease frequently experience delayed postoperative recovery. The impact of different anesthetic techniques on recovery quality remains uncertain. This study compared the effects of propofol-based total intravenous anesthesia and sevoflurane-based inhalational anesthesia on postoperative recovery in these patients. Methods Seventy-six patients scheduled for elective revascularization surgery were randomized to either propofol TIVA or sevoflurane inhalational anesthesia. Anaesthesia in the propofol group was maintained by intravenous infusion of propofol. Anaesthesia in the sevoflurane group was maintained by inhalation of sevoflurane. The primary outcome was the Quality of Recovery-15 (QoR-15) score on postoperative days 1–3. Secondary outcomes included Postoperative nausea and vomiting, pain, sleep quality, delirium, postoperative complications, and length of hospital stay. Results Seventy-three patients were included in the analysis. No significant differences were observed in QoR-15 scores between the groups at any timepoint. The sevoflurane group required higher doses of norepinephrine, more intraoperative fluids, and produced greater urine output. Although extubation time was longer in the propofol group, these patients required fewer rescue antiemetics and reported better sleep quality on the first postoperative day. Conclusions Neither propofol nor sevoflurane anesthesia significantly influenced overall recovery quality. This study provides a conceptual framework and evidence-based support for individualized anesthesia management in vulnerable populations, such as patients with cerebrovascular diseases. Trial registration : This study was registered with the China Ethics Committee of Registering Clinical Trials, Sichuan, China (ChiCTR2400087467; date: July 29, 2024).