Comparison of cerebral oxygenation inpatients undergoing gynecological laparoscopic surgery under sevoflurane- versus propofol-based anesthesia

Abstract

Objective To compare the cerebral oxygenation in the patients undergoing gynecological laparoscopic surgery under sevoflurane- versus propofol-based anesthesia. Methods Fifty adult patients, aged 18-56 yr, weighing 55-72 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, with hemoglobin≥110 g/L, undergoing elective gynecological laparoscopic surgery under general anesthesia, were equally and randomly divided into sevoflurane group(group S)and propofol group(group P)using a random number table.Anesthesia was induced with iv midazolam 0.04 mg/kg, sufentanil 1.5-2.0 μg/kg, rocuronium 0.9 mg/kg, and propofol 1.5-2.0 mg/kg.Anesthesia was maintained with inhalation of sevoflurane(2.0%-2.6%)in group S, or with target-controlled infusion of propofol(plasma concentration 2.5-4.0 μg/ml)in group P. The concentrations of sevoflurane and propofol were adjusted to maintain bispectral index value at 40-50.In both groups, remifentanil was given by target-controlled infusion(target plasma concentration 2 ng/ml), and vecuronium 0.06-0.08 mg/kg was injected intermittently to maintain muscle relaxation.The regional cerebral oxygen saturation(rSO2)was recorded after induction and at 10 min before pneumoperitoneum(T1), at 10 min of pneumoperitoneum in the Trendelenburg position(T2), and at 10 min after the end of pneumoperitoneum(T3). The occurrence of cerebral oxygen desaturation was recorded during surgery. Results The rSO2 was significantly higher at T2, 3 in group S than in group P(P 0.05), and the rSO2 was significantly decreased at T2, 3 in group P(P<0.05). The incidence of cerebral oxygen desaturation was 12% in group P, and cerebral oxygen desaturation was not detected in group S. Conclusion Sevoflurane-based anesthesia produces no effect on rSO2, however, propofol-based anesthesia can decrease rSO2 in the patients undergoing gynecological laparoscopic surgery, and sevoflurane-based anesthesia is more suitable for gynecological laparoscopic surgery. Key words: Anesthetics, inhalation; Propofol; Laparoscopy; Brain; Oxygen