Comparison of the effect of sevoflurane or propofol anesthesia on the regional cerebral oxygen saturation in patients undergoing carotid endarterectomy: a prospective, randomized controlled study

Abstract

Background The monitoring of regional cerebral oxygen saturation (SrO 2 ) using near-infrared spectroscopy is useful method to detect cerebral ischemia during. Sevoflurane and propofol decrease cerebral metabolic rate (CMRO 2 ) 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 SrO 2 were different in patients with deficits of CBF. This study compared the effect of sevoflurane and propofol on SrO 2 of patients undergoing cerebral endarterectomy (CEA). Method Patients 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 (SrO 2 , SpO 2 ), 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. Results During stage 1 period (before carotid artery clamping), the mean value of the relative changes in SrO 2 was higher ( P = 0.033) and the maximal decrease in SrO 2 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). SrO 2 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). Conclusion Propofol-remifentanil anesthesia was comparable with sevoflurane-remifentanil anesthesia in an aspect of preserving the SrO 2 in patients undergoing carotid endarterectomy. Trial registration Clinical Trials.gov identifier: NCT02609087 , retrospectively registered on November 18, 2015.

Effects of sevoflurane and propofol anesthesia on cerebral oxygenation in patients undergoing carotid endarterectomy

“…The mean rScO 2 was similar between the ipsilateral and contralateral hemispheres from induction until carotid artery clamping. Similar to earlier results, the decrease in mean rScO 2 noted in the present work was significantly different between the two hemispheres (18,30). rScO 2 values were significantly lower in the sevoflurane group than in the propofol group before extubation in the ICU and in female patients than in male patients in the propofol group during cross-clamping.…”

“…Previous RCTs comparing the effects of propofol and sevoflurane anesthesia among non-vascular surgery patients suggested that sevoflurane is better than propofol for maintaining cerebral oxygen balance (12,20). In contrast to these studies, Park et al showed that propofolremifentanil anesthesia is comparable with sevofluraneremifentanil anesthesia in preserving cerebral oxygen balance in patients undergoing carotid endarterectomy with carotid cross-clamping, as assessed by NIRS (30). Our results support the findings of Park et al and revealed a statistically significant difference in cerebral oximetry values between male and female patients receiving propofol anesthesia during cross-clamping of the carotid artery.…”

Effects of end-tidal carbon dioxide levels in patients undergoing direct revascularization for Moyamoya disease and risk factors associated with postoperative complications

“…Sevoflurane decreases cerebral blood flow (CBF) at concentrations <1 minimum alveolar concentration (MAC) but increases CBF at concentrations >1 MAC, while propofol decreases CBF in a dose-dependent manner. [ 14 ] Marianna et al showed that sevoflurane anesthesia at 1 MAC can preserve cerebral autoregulation and CO 2 reactivity. [ 15 ] Intravenous anesthesia with propofol has the potential to provide brain protection and preserve regional CBF (rCBF) in the frontal lobes in revascularization surgery for MMD.…”

“…[ 17 ] A prospective randomized controlled study by Park demonstrated that propofol-remifentanil anesthesia was comparable to sevoflurane-remifentanil anesthesia in terms of preserving regional cerebral oxygen saturation in patients undergoing carotid endarterectomy. [ 14 ] Overall, there is not enough evidence associating the use of a particular maintenance agent with better outcomes in patients with MMD. Further multicenter randomized controlled trials need to be done to establish which anesthetic agent is best for adult patients with MMD.…”

Postoperative recovery of patients with differential requirements for sevoflurane after abdominal surgery

“…Clinical signs, such as heart rate (HR) and blood pressure, are unreliable when evaluating an anaesthetic depth and preventing intraoperative awareness. [ 6 – 8 ] Moreover, early attempts were made to monitor the depth of anaesthesia using electroencephalography, [ 9 ] the entropy index, [ 10 ] cerebral oxygen saturation, [ 11 ] and end-tidal concentrations of inhaled anaesthetics. [ 12 ] However, these indicators have limitations.…”