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Objective To compare the effect on 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 Thirty-four patients were randomly divided into the propofol combined with remifentanil group (group A,n=16) and the desflurane combined with remifentanil group (group B,n =18).The B-ultrasound under the guide of retrograde catheterization through right internal jugular vein and artery was prepared after the patients entered the operation room.Atropine,propofol,fentanyl,rocuronium were used in the induction of anesthesia.The mechanical ventilation was applied after conventional trachea cannula.Once patients were anesthetized steadily,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),arterial blood gluxose (Ga),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) 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.Results (1) The value of SjvO2,PjvO2,CjvO2 and CaO2 in group B was significantly higher than that in group A (P＜0.001);The value of AVDO2 and CEO2 in group B was lower than that in group A (P＜0.05);(2) The value of Gv and Ga in group B was higher than that in group A (P＜0.05);There were no significant differences about CGU in two groups (P＞0.05);(3) The value of CLP in group B was lower than that in group A (P＜0.05);there were no significant differences about Ljv and La in two groups (P＞0.05);(4) Compared with the value at moment of T1 between group A and group B,the value ofPaO2,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 metabolism;(2) For the cerebral protection of neurosurgery operation,it seems that the effect of intravenous inhalation anesthesia is more stronger than total intravenous anesthesia.
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Objective To compare the effects of desflurane and sevoflurane on somatosensory evoked potentials (SEP) in patients undergoing spine neurosurgery. Methods Thirty patients with ASA grades I-Ⅱand undergoing spinal deformity orthopaedic surgery were selected and divided into two groups: desflurane group and sevoflurane group (n=30) . Bispectral index (BIS),the state of muscle relaxation, SEP and hemodynamics were monitored during operation. By maintaining the BIS in the range of 35-45,the state of muscle relaxation disappeared and hemodynamic became stable. Adjust the concentration of anesthetic step by step from 0 to 0.3, 0.6 and 0.9 maximum alveolar concentrations (MAC), then inhaled different concentrations of drugs. Record the incubation period and amplitude of SEP before inhaling anesthetics (based on the value), in the moment of achieving each inhaled concentration ( T1, T2 and T3) , and the moment that the inhaled anesthetics blows completely (regression value) . The percentages of T1, T2, T3, and the regression value compared with basic value were calculated.Results Compared with the basic value, T1, T2 and T3 of left arm, left leg and right leg in desflurane group, T2 and T3 of right arm in desflurane group, T2 and T3 of left arm, left leg and right arm in sevoflurane group,and T2 and T3 of right leg in sevoflurane group showed incubation period delaying ( <0.05) . And the incubation period extended along with the increase of inhaled anesthetics dosage. Compared with the basic value,T1,T2 and T1 of left arm and left leg in desflurane group,T1 of right arm in desflurane group, T1 and T2 of right leg in desflurane, T3 of left arm in sevoflurane group, T1 and T3 in left leg in sevoflurane group had decreased amplitude ( < 0.05), especially T1. Compared with desflurane, sevoflurane showed a weaker inhibition effect on the incubation period and amplitude of T1,T2,T3 of left arm and left leg,T2 and T3 of right arm and right leg, and the amplitude of T1 of right leg ( < 0.05) . Conclusion Both of desflurane and sevoflurane have inhibition effect on SEP. The inhibition effect gradually strengthens along with the increasing of dose. The inhibition effect of desflurane is stronger than sevoflurane.
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Objective To investigate the effects of desflurane on hemodynamics in aged patients.Methods Thirty ASA gradeⅠ Ⅱaged patients,scheduled for elective surgery,were studied. Anesthesia was induced with intravenous thiopentol,succinylcholine and fentanyl.After intubation coesophageal Doppler monitor was performed to measure CO,PV,HR,FTC,CVP,CI,MAP and SVR following inhalation of desflurane at 0 5MAC,1 0MAC,1 5MAC and 2 0MAC respectively.Results Compared with those before inhalation desflurane,MAP and SVR decreased more significantly at 1 0MAC,1 5MAC and 2 0MAC(P0 05),HR and FTC increased significantly at 1.0MAC,1.5MAC and 2.0MAC(P