Comparison of serum level S100B in patients inducted with desflurane and propofol

Abstract

Introduction The problem of postoperative cognitive dysfunction today remains extremely relevant. One way to protect the brain is to use drugs that increase tolerance to intraoperative ischemia. The aim of this study is compare protective effects on brain during endarterectomy in terms of intravenous (propofol) and inhalation (desflurane) anesthesia. Methods The study included patients over 65 with carotid atherosclerosis(Stenosis>70%) All patient were divided in two groups. Both groups underwent standard anesthesia induction with fentanyl (10 mcg/kg), propofol (2,0 mg/kg), and pancuronium bromide (0.1 mg/kg) In group D anesthesia was maintained on O2/air/ desflurane at concentrations up to 1.3 MAC and in group P by continuous infusion of propofol. Serum level of baseline protein S100B (the possibility of using S100b, as a marker and prognostic index for brain tissue damage during ischemic stroke has been proven [1,2] before surgery (T1), immediately after surgery (T2), and day after surgery(T3) was evaluated in all patients. All patients were continuously monitored for Heart rate, invasive blood pressure, SpO2, urine output, BIS index, capnography, brain dopplerography, nasopharyngeal temperature, and arterial blood gases. During the clamping of the carotid vessels, sympathomimetic support with norepinephrine was used to achieve MBP in the region of 100 mm Hg if required. Results The concentration of 100b in both groups did not differ at T1. The serum level of s100B at the T2 and T3 was significantly higher in group P (mediana 0,12 ng/l for group D vs 0,30 ng/l for group P in T2 (p = 0,002)); (mediana 0,15 ng/l for group D vs 0,44 ng/l for group P in T3 (p = 0,001)) Discussion The serum level of the S100b marker in the postoperative period was significantly higher when TIVA was performed. Probably desflurane has pharmacological protective properties on the brain, but it requires additional analysis. The problem of postoperative cognitive dysfunction today remains extremely relevant. One way to protect the brain is to use drugs that increase tolerance to intraoperative ischemia. The aim of this study is compare protective effects on brain during endarterectomy in terms of intravenous (propofol) and inhalation (desflurane) anesthesia. The study included patients over 65 with carotid atherosclerosis(Stenosis>70%) All patient were divided in two groups. Both groups underwent standard anesthesia induction with fentanyl (10 mcg/kg), propofol (2,0 mg/kg), and pancuronium bromide (0.1 mg/kg) In group D anesthesia was maintained on O2/air/ desflurane at concentrations up to 1.3 MAC and in group P by continuous infusion of propofol. Serum level of baseline protein S100B (the possibility of using S100b, as a marker and prognostic index for brain tissue damage during ischemic stroke has been proven [1,2] before surgery (T1), immediately after surgery (T2), and day after surgery(T3) was evaluated in all patients. All patients were continuously monitored for Heart rate, invasive blood pressure, SpO2, urine output, BIS index, capnography, brain dopplerography, nasopharyngeal temperature, and arterial blood gases. During the clamping of the carotid vessels, sympathomimetic support with norepinephrine was used to achieve MBP in the region of 100 mm Hg if required. The concentration of 100b in both groups did not differ at T1. The serum level of s100B at the T2 and T3 was significantly higher in group P (mediana 0,12 ng/l for group D vs 0,30 ng/l for group P in T2 (p = 0,002)); (mediana 0,15 ng/l for group D vs 0,44 ng/l for group P in T3 (p = 0,001)) The serum level of the S100b marker in the postoperative period was significantly higher when TIVA was performed. Probably desflurane has pharmacological protective properties on the brain, but it requires additional analysis.