Abstract
BackgroundThe monitoring of regional cerebral oxygen saturation (SrO2) using near-infrared spectroscopy is useful method to detect cerebral ischemia during. Sevoflurane and propofol decrease cerebral metabolic rate (CMRO2) in a similar manner, but the effects on the cerebral blood flow (CBF) are different. We hypothesized that the effects of sevoflurane and propofol on SrO2 were different in patients with deficits of CBF. This study compared the effect of sevoflurane and propofol on SrO2 of patients undergoing cerebral endarterectomy (CEA).MethodPatients undergoing CEA were randomly assigned to the sevoflurane or propofol group (n = 74). The experiment was preceded in 2 stages based on carotid artery clamping. The first stage was from induction of anaesthesia to immediately before clamping of the carotid artery, and the second stage was until the end of the operation after clamping of the carotid artery. Oxygen saturation (SrO2, SpO2), haemodynamic variables (blood pressure, heart rate), respiratory parameters (end-tidal carbon dioxide tension, inspired oxygen tension), concentration of anesthetics, and anesthesia depth (bispectral index score) were recorded.ResultsDuring stage 1 period (before carotid artery clamping), the mean value of the relative changes in SrO2 was higher (P = 0.033) and the maximal decrease in SrO2 was lower in the sevoflurane group compared with the propofol group (P = 0.019) in the contralateral (normal) site. However, there is no difference in ipsilateral site (affected site). SrO2 decreased after carotid artery clamping and increased after declamping, but the difference was not significant between two groups. Changes in mean arterial blood pressure was lower in sevoflurane group than propofol group after the carotid artery declamping (P = 0.048).ConclusionPropofol-remifentanil anesthesia was comparable with sevoflurane-remifentanil anesthesia in an aspect of preserving the SrO2 in patients undergoing carotid endarterectomy.Trial registrationClinical Trials.gov identifier: NCT02609087, retrospectively registered on November 18, 2015.
Highlights
The monitoring of regional cerebral oxygen saturation (SrO2) using near-infrared spectroscopy is useful method to detect cerebral ischemia during
Among the 74 patients initially included in the study, 2 patients (1 in the sevoflurane group and 1 in the propofol group) with low Regional cerebral oxygen saturation (SrO2) and 2 patients in the propofol group that showed sustained hypotension or arrhythmia intraoperatively were excluded (Fig. 1)
There were no significant differences in preoperative values of SrO2, arterial blood pressure, peripheral arterial oxygen saturation, or heart rate between the groups (Table 2)
Summary
The monitoring of regional cerebral oxygen saturation (SrO2) using near-infrared spectroscopy is useful method to detect cerebral ischemia during. Sevoflurane and propofol decrease cerebral metabolic rate (CMRO2) in a similar manner, but the effects on the cerebral blood flow (CBF) are different. This study compared the effect of sevoflurane and propofol on SrO2 of patients undergoing cerebral endarterectomy (CEA). Monitoring of the regional cerebral oxygen saturation (SrO2) using near-infrared spectroscopy (NIRS) is a noninvasive method to observe the oxygen balance of the brain. SrO2 determined by arterial oxygen saturation, cerebral blood flow (CBF), haemoglobin and cerebral metabolic rate (CMRO2) reflect the balance of oxygen supply and demand of brain tissue [5]. Monitoring of SrO2 using NIRS is suggested to be a useful method to detect brain ischaemia during CEA [7]
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