Study On The Protective Effect Of Desflurane Combined With Propofol On The Brain Of Patients With Moyamoya Disease Undergoing Cerebral Revascularization

ObjectiveTo observe the effects of desflurane and propofol on cerebral oxygen supply and demand,brain energy metabolism,neuron specific enolase(NSE),S100 β protein and postoperative complications in patients with moyamoya disease undergoing STA-MCA branch anastomosis and to study the protective effect of desflurane and propofol on the brain of patients with moyamoya disease.Subjects and MethodsNinety patients,who were diagnosed with moyamoya disease,aged 18-65 years,BMI 18-25 kg/m2,ASA Ⅰ or Ⅱ and they were undergoing selective cerebral revascularization.A random number generator assigned patients into three groups(n=30):desflurane group(D group),propofol group(P group)and desflurane-propofol group(PD group),anesthesia was maintained with desflurane(D group,end-tidal concentration 4%-6%),propofol MCI(P group,4-6mg·kg-1·h-1)or propofol MCI combined with desflurane(PD group,2-3mg·kg-1·h-1 and end-tidal concentration 2%-3%)and remifentanil MCI(0.1-0.3g·kg-1·min-1).Anesthesia was induced with etomidate 0.3mg/kg,sufentanil 0.4-0.5ug/kg,and cis-atracurium 0.15-0.2mg/kg.HR and MAP were recorded at the following time-points:moment prior to induction of anesthesia(T1),15 minutes after intubation(T2),30 minutes after surgery starting(T3),opening the dura mater(T4),end of revascularization(T5),and the end of surgery(T6).Blood sample from bulb of internal jugular vein and peripheral artery were collected at T2,T3,T4,T5 and T6,which were used for blood gas analysis.Then we calculated the arterio-venous oxygen content difference(Da-jvO2),cerebral oxygen extraction rate(CO2ER),rates of glucose uptake(GluER),brain lactate generation rates(LacPR)and lactate oxygen index(LOI).The operation time,middle cerebral artery occlusion time,postoperative hospital stay,postoperative complications and and the mRS score within 3 months after surgery were recorded.The concentrations of NSE and S100β protein were measured by ELISA at three times of T2,T6 and T7(6h after operation).ResultsThere was no significant difference in age,weight,ASA grade,gender,operation side,disease type,Operation time,middle cerebral artery occlusion time,MAP,HR and BIS among the three groups(P>0.05).Comparison among groups:There was no significant difference in Da-jvO2 among the three groups at T2(P>0.05).At T3,T4,T5 and T6,the level of Da-jvO2 in group D was lower than that in group P(P<0.05).There was no significant difference between group PD and group P or group D(P>0.05);At T2 and T3 time points,there was no significant difference in CO2ER and SjvO2 among the three groups(P>0.05).At T4,T5 and T6 time points,the level of CO2ER in group D was lower than that in group P(P<0.05)and there was no significant difference in PD group compared with group P and group D(P>0.05)and the level of SjvO2 in group D was higher than that in group P,the difference was statistically significant(P<0.05).The level of SjvO2 in PD group was higher than that in group P at T4 and T5,the difference was statistically significant(P<0.05)and there was no statistical difference between group D and PD group(P>0.05).There was no significant difference in NSE and S100β protein among the three groups at T2,T6 and T7(P>0.05).Comparison intra-group:Compared with T2,the levels of Da-jvO2 and CO2ER in group D decreased significantly(P<0.05)at T3,T4,and T6 time points,and the levels of Da-jvO2 in group PD decreased and SjvO2 increased in group D(P<0.05)at T6 time point;Compared with T3,at T4 and T5,there was a significant difference in SjvO2 reduction in P group(P<0.05)and Da-jvO2 in group D decreased and SjvO2 increased(P<0.05)at T6 time point;Compared with T4,at the time of T6,SjvO2 and CO2ER in group P increased,while Da-jvO2 in group D,P and PD decreased(P<0.05);Compared with T5,the levels of Da-jvO2 and CO2ER in the three groups decreased at T6 time point and the difference was statistically significant and SjvO2 increased in group P and D(P<0.05).Compared with T2,NSE and S100β protein levels of the three groups were increased at T6 and T7 time points,and the difference was statistically significant(P<0.05).There was no significant difference in SaO2,PaCO2,Hb,GluER,LacPR,LOI,postoperative complications,hospitalization days and mRS score among the three groups(P>0.05).Conclusion1.Desflurane and propofol can be safely used in vascular reconstruction of moyamoya disease.2.Desflurane or propofol with remifentanil can maintain cerebral oxygen supply-consumption and brain energy metabolism balance.Compared with propofol,desflurane can maintain the balance between cerebral oxygen supply and demand better during cerebral revascularization in the patients with moyamoya disease.3.The effects of desflurane and propofol on neurological function in patients with moyamoya disease undergoing revascularization are similar.