The Neuroprotective Effect of Thiopental on the Postoperative Neurological Complications in Patients Undergoing Surgical Clipping of Unruptured Intracranial Aneurysm: A Retrospective Analysis.

Byung-Gun Kim,Jiwon Han,Jung-Hee Ryu,Si Un Lee,Yu Kyung Bae,Young-Tae Jeon,Chang-Hoon Koo

doi:10.3390/jcm10061197

Abstract

Although thiopental improved neurological outcomes in several animal studies, there are still insufficient clinical data examining the efficacy of thiopental for patients undergoing surgical clipping of unruptured intracranial aneurysm (UIA). This study validated the effect of thiopental and investigated risk factors associated with postoperative neurological complications in patients undergoing surgical clipping of UIA. In total, 491 patients who underwent aneurysm clipping were included in this retrospective cohort study. Data regarding demographics, aneurysm characteristics, and use of thiopental were collected from electronic medical records. Propensity score matching and logistic regression analysis were used. After propensity score matching, the thiopental group showed a lower incidence of the postoperative neurological complications than non-thiopental group (5.5% vs. 17.1%, p = 0.001). In multivariate analysis, thiopental reduced the risk of postoperative neurological complications (odds ratio (OR) 0.26, 95% confidence interval (CI) 0.13 to 0.51, p < 0.001) while aneurysm size ≥ 10 mm (OR 4.48, 95% CI 1.69 to 11.87, p = 0.003), and hyperlipidemia (OR 2.24, 95% CI 1.16 to 4.32, p = 0.02) increased the risk of postoperative neurological complications. This study showed that thiopental was associated with the lower risk of neurological complications after clipping of UIA.

Highlights

Unruptured intracranial aneurysm (UIA) has a reported incidence of up to 3% in the general population [1]
491 patients who had undergone surgical clipping of UIA were enrolled in this study
This study showed that aneurysm size and hyperlipidemia were independently associated with postoperative neurological complications in patients who underwent UIA clipping

Summary

Introduction

Unruptured intracranial aneurysm (UIA) has a reported incidence of up to 3% in the general population [1]. Surgical clipping is considered suitable for the treatment of UIA. During surgical clipping of UIA, temporary clipping of parent artery is commonly performed to soften the UIA, thereby reducing intraoperative rupture and facilitating approach to vessels [2,3]. Temporary clipping is associated with cerebral ischemia and postoperative neurological complications [4,5,6]. Cerebral infarction occurs in approximately 11% of patients who have undergone surgical clipping of UIA [7]. Some measures, such as hypothermia, neurophysiologic monitoring, or pharmacological interventions, have been suggested to prevent neurological impairment after UIA clipping [8,9,10]

Methods

Results

Discussion

Conclusion