Comparison Of Effects Of Intraoperative Cerebral Metabolism Between Total Intravenous Anesthesia And Intravenous Inhalation Anesthesia In Patients In Neurosurgery

Objective:To compare the effect of intraoperative cerebral metabolism between the propofol combined with remifentanil infusion in total intravenous anesthesia and the desflurane combined with remifentanil intravenous inhalation anesthesia in patients in neurosurgery.Methods:34 patients (17 males,17 females) with ASA I-II,scheduled for neurosurgery operation in the Second Affiliated Hospital of Kunming Medical University from December 2014 to November 2015 were selected,and were randomly divided into the propofol combined with remifentanil group (group P, n=16) and the desflurane combined with remifentanil group (group D, n=18). The B-ultrasound under the guide of retrograde catheterization through right internal jugular vein and artery could be prepared for monitoring and sampling after the patients entered the operation room. Atropine 0.01mg/kg, propofol2mg/kg fentanyl 3μg/kg, rocuronium 0.8mg/kg were used in the induction of anesthesia. The mechanical ventilation was applied after conventional trachea cannula. Tidal volume should be set up with 8～10ml/kg,the respiratory rate should be 12 times per minute, SpO2 maintained at 98%～100%, PetCO2 maintained at 35-45mmHg during mechanical ventilation. The plasma concentration of the target control infusion remifentanil was 2.0ng/ml,and after the operation the target concentration was 2.6-3.5 ng/ml. In group P which the plasma concentration of the target control infusion propofol was 2.0μg/ml,and after the operation the target concentration was 5～7μg/ml.And in group D MAC of desflurane maintained at 1.0. BIS maintained at 35-45.Anesthetics were stopped after the operation. Once patients were anesthetized steadily,blood pressure(BP),heart rate(HR) and bispectral index(BIS) at different time[before anesthesia induction(T1),1 hours after the start of the operation(T2),2 hours after the start of the operation(T3),half an hour after the operation]were collected. Jugular bulb venous Blood and arterial blood were collected for blood gas analysis at the corresponding time points to get jugular bulb venous oxygen saturation(SjvO2), jugular bulb venous oxygen partial pressure (PjvO2). Jugular Bulb venous hemoglogin (Hbv),jugular bulb venous lactate(Ljv), jugular bulb venous gluxose(Gv), arterial oxygen saturation (SaO2), arterial oxygen pressure (PaO2), arterin (Hba), arterial blood lactate (La) and arterial blood gluxose (Ga).And to calculate arterial blood oxygen content (CaO2), jugular bulb venous oxygen content (CjvO2), arteriovenous oxygen difference(AVDO2), cerebral extraction of oxygen(CEO2), cerebral lactate production rate(CLP) and cerebral glucose uptake rate(CGU).Results:1.There were no statistical differences about BIS,BP,HR,Hbv,SaO2,PaO2 and Hba between group P and group D at four time points (p>0.05). There was a downward trend but no statistical significance (p>0.05) that compared the value of BP and HR at the time of T2 and T3 with the value at the time of T1 and T4 within the group comparison. The values of BIS at the time of T2 and T3 were lower than which at the time of T1 (p<0.05). The value of Hbv and Hba decreased continuously with time (p<0.05).2. At moment of T2,T3 and T4 the value of SjvO2,PjvO2,CjvO2 and CaO2 in group D was significantly higher than that in group P(p<0.001); The value of AVDO2 and CEO2 in group D was lower than that in group P (p<0.05).3. At moment of T2,T3 and T4 the value of Gv and Ga in group D was higher than that in group P (p<0.05); There were no significant differences about CGU in two groups (p>0.05).4. At moment of T2,T3 and T4 the value of CLP in group D was lower than that in group P (p<0.05); there were no significant differences about Ljv and La in two groups (p>0.05).5. Compared with the value at moment of T1 between group P and group D, the value of PaO2,SaO2,PjvO2 and SjvO2 were increased with time (p<0.05),the value of CaO2,CjvO2,AVDO2 and CEO2 showed a downward trend (p<0.05)Conclusion:1.Both total intravenous anesthesia and intravenous inhalation anesthesia can reduce the cerebral oxygen consumption and cerebral extraction of oxygen, which can reduce the cerebral oxygen metabolism.2.Compared with total intravenous anesthesia, cerebral lactate production rate of intravenous inhalation anesthesia was lower.3.For the cerebral protection of neurosurgery operation, it seems that the effect of intravenous inhalation anesthesia is more stronger than total intravenous anesthesia.