Effect of different anesthesia methods on cerebral oxygen metabolism in patients with severe traumatic brain injury

Abstract

Objective To investigate the effects of different anesthesia methods on cerebral oxygen metabolism in patients with severe traumatic brain injury.Methods Forty-five patients with severe traumatic brain injury from March 2011 to March 2013 were divided into propofol intravenous anesthesia group(group A),sevoflurane inhalation anesthesia group(group B) and intravenous inhalational anesthesia group (group C) by random digits table method with 15 cases each.The mean artery pressure (MAP),heart rate (HR) before anesthesia,immediately after tracheal intubation,2 minutes after intubation,10 min and 30 min after operation set and operation end were observed.The oxygen content of jugular venous (SjvO2),jugular bulb venous oxygen content (Da-jvO2) and cerebral metabolic rate for oxygen (CERO2) before anesthesia induction,immediately finish anesthesia induction,30 min and 1 h after operation set and operatin end were calculated.Results The SjvO2 values in three groups were at 30 min,1 h after operation set and operation end was higher than that before anesthesia induction (group A:0.662 ±0.077,0.689 ±0.067,0.685 ±0.066 vs.0.623 ±0.083; group B:0.661 ±0.074,0.681 ±0.072,0.661 ±0.069 vs.0.598 ±0.092; group C:0.715 ± 0.072,0.743 ± 0.070,0.713 ± 0.075 vs.0.631 ± 0.078),and there was significant difference (P ＜ 0.05).The Da-jvO2 values,CERO2 at 30 min,1 h after operation set and operation end was lower than that before anesthesia induction in three groups [group A:Da-jvO2:(41.2 ± 6.3),(41.6 ± 8.1),(44.2 ± 6.3) ml/L vs.(49.2 ± 9.2) ml/L,CERO2:(33.0 ± 1.9)％,(32.7 ± 2.0)％,(32.3 ± 1.9)％ vs.(36.0 ±2.3)％; group B:Da-jvO2:(41.8 ± 5.6),(40.2 ± 6.9),(41.8 ± 5.6) ml/L vs.(51.3 ± 8.6) ml/L,CERO2:(33.2 ±2.1)％,(33.0 ±2.6)％,(32.8 ±2.1)％ vs.(34.7 ±3.1)％ ; group C:Da-jvO2:(39.5 ±6.8),(38.7 ±7.0),(40.2 ±6.8) ml/L vs.(48.8 ±9.7) ml/L,CERO2:(31.8 ±2.9)％,(31.5 ±3.1)％,(32.9 ±2.3)％ vs.(35.1 ± 2.9)％],and there was significant difference (P ＜ 0.05).And group C was decreased more significantly (P＜0.05).There was no significant difference in MAP,HR among three groups (P＞0.05).Conclusion Propofol intravenous anesthesia and sevoflurane inhalation anesthesia can effectively reduce perioperative cerebral metabolic rate of oxygen,and the balanced anesthesia has better cerebral protection with the stable hemodynamic. Key words: Craniocerebral trauma; Propofol; Sevoflurane; Cerebral oxygen metabolism