Abstract
PurposeSteep Trendelenburg position and pneumoperitoneum during robotic-assisted laparoscopic prostatectomy (RALP) increase intracranial pressure (ICP) and may alter cerebral blood flow (CBF) and oxygenation. Volatile anesthetics and propofol have different effects on ICP, CBF, and cerebral metabolic rate and may have different impact on cerebral oxygenation during RALP. In this study, we measured jugular venous bulb oxygenation (SjO2) and regional oxygen saturation (SctO2) in patients undergoing RALP to evaluate cerebral oxygenation and compared the effects of sevoflurane and propofol. We also verified whether SctO2 may be an alternative to SjO2.MethodsFifty patients scheduled for RALP were randomly assigned to undergo sevoflurane (group S) or propofol (group P) anesthesia. SjO2, SctO2, mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), central venous pressure (CVP), partial pressures of arterial oxygen (PaO2) and carbon dioxide (PaCO2), hemoglobin concentration (Hb), Bispectral Index (BIS) and nasopharyngeal temperature (BT) were recorded 5 min before surgery commencement, 5 min after pneumoperitoneum, 5, 30, 60, 90, and 120 min after pneumoperitoneum in a Trendelenburg position, and after desufflation in a supine position.ResultsSjO2 was significantly higher in group S than in group P at all measurement points [group S vs. group P: 77 % (11) vs. 65 % (13), mean of all measurement points (1SD); p < 0.01]. Linear regression analysis (β = 0.106; r 2 = 0.065; p = 0.004) shows a weak relationship between SjO2 and SctO2.ConclusionsSevoflurane maintains higher SjO2 levels than propofol during RALP. SctO2 does not accurately reflect SjO2.
Highlights
Robotic-assisted laparoscopic prostatectomy (RALP) requires a steep Trendelenburg position and pneumoperitoneum, both of which can increase intracranial pressure (ICP) [1, 2]
These aspects must be clarified if we are to demonstrate the superiority of sevoflurane over propofol in a clinical setting because they might occur prior to a decrease in SjO2 or cerebral perfusion pressure
A study comparing sevoflurane and propofol anesthesia among patients with baseline SjO2 values
Summary
Robotic-assisted laparoscopic prostatectomy (RALP) requires a steep Trendelenburg position and pneumoperitoneum, both of which can increase intracranial pressure (ICP) [1, 2]. Sevoflurane and propofol are commonly used anesthetics, they have different effects on cerebral blood flow (CBF) and the cerebral metabolic rate for oxygen (CMRO2). At the medium-to-high concentrations commonly used in clinical settings, the direct vasodilatory effect becomes dominant, causing CBF and the CBF/CMRO2 ratio to increase. With sevoflurane, this effect is accompanied by an increase in cerebral blood volume (CBV) and an elevated ICP [5]. In RALP, where ICP is already increased, it is conceivable that the CBV increase caused by volatile anesthetics could further increase ICP and in turn lower the CBF/ CMRO2 ratio and cerebral oxygenation.
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