Remifentanil-Propofol versus Propofol Alone in Patients with Severe Traumatic Brain Injury: A Retrospective Cohort Study on Anesthesia Outcomes.

Objective: To compare the effects of remifentanil-propofol versus propofol alone on anesthesia outcomes in patients undergoing surgery for severe traumatic brain injury (TBI). Methods: In this single-center, retrospective cohort study, we analyzed the data of 113 consecutive severe TBI (GCS <9) patients who underwent emergency neurosurgery. Patients were allocated into two groups based on the anesthesia maintenance regimen: the control group (n=56) received a continuous infusion of propofol alone, while the observation group (n=57) received a combination of remifentanil and propofol. The groups were well-matched at baseline. We compared anesthesia recovery times, hemodynamic parameters (SpO2, MAP, HR) at various time points, postoperative pain (VAS) and agitation (RSAS) scores, levels of inflammatory (TNF-α, IL-6) and neurological damage (S-100β, NSE) biomarkers, and 3-month neurological outcomes using the Glasgow Outcome Scale (GOS). Results: Compared to the control group, the observation group demonstrated significantly shorter extubation time (13.54 ± 3.23 vs 24.79 ± 5.71 min, P < 0.001) and awakening time (8.72 ± 2.43 vs 17.21 ± 3.96 min, P < 0.001). The remifentanil-propofol regimen was associated with superior intraoperative hemodynamic stability for MAP and HR (Group and Interaction effects, P < 0.05). At 24 hours postoperatively, the observation group also exhibited lower VAS and RSAS scores (both P < 0.05), as well as reduced elevations in TNF-α, IL-6, S-100β, and NSE levels (all P < 0.05). Critically, a significantly higher proportion of patients in the observation group achieved a "Good Recovery" on the GOS at 3 months (54.39% vs 25.00%, P = 0.001). Conclusion: For severe TBI surgery, remifentanil-propofol is associated with faster emergence, better hemodynamic control, reduced pain/agitation, attenuated neuro-inflammation, and improved long-term recovery versus propofol alone, suggesting significant clinical benefits. Prospective studies are warranted for confirmation.