Isoflurane Of Propofol Anesthesia On Balance Of Cerebral Oxygen Supply And Consumption And Also On The Stress Response

Objective To study the effects of two anesthestic methods on balance of cerebral oxygen supply and consumption and also on the stress response. Methods Thirty-eight patients undergoing brain tumor resection were randomly divided into two groups: ISO Group (n=20,inducted with midazolam, fentanyl and vecuronium, and maintained with isoflurance 1MAC,30min later followed by 1.5MAC, 30min. and intravenous infusion of fentanyl, vecuronium discontinuously.); PRO Group (n=18, inducted with same medicine as ISO Group , maintained with continuous intravenous infusion of propofol 6mg.kg-1.h-1,30min later followed by 12mg.kg-1.h-1,30min,and fentanyl, vecuronium were gaven discontinuously.). Blood samples were taken from radil artery and bulb of internal jugular vein beforeinduction of anesthesia (T1),just after intubation (T2), 30min (T3) and 60min (T4) after maintenance to detemine the glucose,lactate concentration and to analyse blood gas. ACTH, COR were detemined from venous blood of bulb of internal jugular vein, According to Fick formula , we can calculate CaO2,CjvO2,Ca-jvO2 and OER, At the same time we monitored patients' hemodynamics continuously. Results (1)The changes of hemodynamics ISO Group: MAP at T3 and T4 were decreased very obviously (p<0.01),and lower than that of PRO group at the same time points (p<0.05). At all time points, there were no significant changes of HR; PRO group: MAP at T4 were decreased obviously(p<0.05). HR at T3 and T4 were decreased obviously (p<0.05),and lower than that of ISO group at the same time points (p<0.05). (2) the changes of balance of cerebral oxygen supply and consumption ISO group: CjvO2 at T3 and T4 were increased very obviously, and higher than that of PRO group at the same time points (P<0.01). ERO and Ca-jvO2 at T3 and T4 were all decreased very obviously (P<0.01) , and lower than that of PRO group at the same time points; PRO group:there were no significant changes of the CjvO2,Ca-jvO2 and OER respectively at all time points. (3) the changes of glcose,lactate concentration ISO Group: the lactate concentrations atT4 were increased obviously (p<0.05) and higher than that of PRO group at the same time point. The glucose concentrations at T3 were increased obviously (p<0.05),and was increased very obviously at T4 (p<0.01).They were higher than that of PRO group at the same time points; PRO group:for glucose,lactate concentration ,there were no significant changes respectively at all time points (p>0.05).(4) there were no significant changes of ACTH COR respectively at all time points in two groups (p>0.05). Conclusions because of its function of moderate degree of inhibition to the stress respones and its ability of keeping balance of cerebral oxygen supply and consumption,the anesthetic technique of PRO group is better for brain tumor resection surgery. And if we control the concentration of isoflurane about 1MAC, the anesthetic technique of ISO group is also good.