Acid-base Status and Hemodynamic Stability During Propofol and Sevoflurane-based Anesthesia in Patients Undergoing Uncomplicated Intracranial Surgery

Abstract

Propofol anesthesia may induce metabolic disturbances and sevoflurane anesthesia arterial hypotension. This study compares both techniques regarding acid-base and hemodynamic status during intracranial surgery. Sixty-one patients were randomized into 2 groups according to anesthesia maintenance, a propofol group (n=30), and a sevoflurane group (n=31). The anesthesia protocol including rocuronium and remifentanil infusion was otherwise similar in both groups. Arterial blood samples were drawn every 2 hours during the procedure and upon arrival in the intensive care unit to assess acid-base status. The number of hypotensive and hypertensive events served to assess hemodynamic stability. Metabolic acidosis was more frequent during propofol than sevoflurane anesthesia (7 out of 29 and 1 out of 31, P=0.02). Its severity was linearly correlated with lactate concentration (R=0.32), total dose of propofol (R=0.2), and length of procedure (R=0.28). Hyperlactacidemia was also observed during sevoflurane anesthesia, but without acidosis. Hypertension occurred more frequently during propofol than sevoflurane anesthesia (13 out of 30 vs. 1 out of 31, P<0.001), particularly in patients with a past medical history of hypertension. Higher remifentanil infusion rates reduced the risk of hypertension. Conversely, sevoflurane anesthesia favored arterial hypotension (22 out of 31 vs. 12 out of 30, P=0.015). Preoperative morning administration of antihypertensive medications to patients with a history of arterial hypertension was associated with a low probability of hypertensive events, at the cost of more frequent hypotension. In conclusion, propofol anesthesia for intracranial surgery is more frequently associated with lactic acidosis and hypertension; sevoflurane anesthesia may favor arterial hypotension.

A multicentre, randomised, open-label, controlled trial evaluating equivalence of inhalational and intravenous anaesthesia during elective craniotomy

“…Effects of remifentanil (hypotension and bradycardia) were not unanticipated and have been documented previously. 19,20 Patient satisfaction was likewise comparable for inhalational and i.v. anaesthesia.…”

Drug-induced acid-base disorders

“…PRIS is a rare complication, which is associated with high doses (>4 mg/kg/h) and long-term use (>48 h) of propofol, concomitant steroid therapy, high consumption of vasopressors, and patient age <18 years [38,39]. The incidence of PRIS is~1 % in adult patients [40].…”

Propofol administration in patients with methylmalonic acidemia and intracellular cobalamin metabolism disorders: a review of theoretical concerns and clinical experiences in 28 patients

“…Moreover, though propofol may increase the risk of lactic acidosis in patients undergoing intracranial surgery, and, prolonged propofol infusion was not found to cause lactate elevations in patients undergoing spine surgery (Rozet et al 2009). Similarly, propofol had no effect on oxidative stress or on lactate and pyruvate levels in children undergoing elective cardiac surgery for congenital heart disease (Bonhomme et al 2009; Rozet et al 2009; Dumaresq et al 2011). Mitochondrial effects of propofol could be of importance in our patients because mut MMA, and likely other forms of isolated MMA as well as cblC deficiency (Ben-Omran et al 2007), features a distinct mitochondriopathy, which is characterized by formation of megamitochondria and decreased Complex IV activity, in human and mice hepatocytes (Brusque et al 2002; Chandler et al 2009).…”