ABSTRACT
Objective To evaluate the effects of sevoflurane-remifentanil anesthesia on the balance between cerebral oxygen supply and demand during cerebral revascularization for ischemic moyamoya disease by monitoring regional cerebral O2 saturation (rSO2) with near infrared spectroscopy.Methods Forty patients of both sexes aged 19-59 yr with a body mass index of 19-25 kg/m2 undergoing superficial temporal artery-middle cerebral artery anastomosis were randomly allocated into 2 groups (n =20 each):propofol-remifentanil group (group PR) and sevoflurane-remifentanil group (group SR).Radial artery was cannulated for direct BP monitoring and blood sampling.Near infrared spectroscopy probe was placed on the forehead.Anesthesia was induced with propofol TCI (Cp =5 μg/ml),fentanyl 3 μg/kg and rocuronium 0.6 mg/kg.The patients were mechanically ventilated after tracheal intubation (VT 8-10 ml/kg,RR 10-12 bpm,I∶ E 1∶2,FiO2 =1.0).PETCO2 was maintained at 35-40 mm Hg.Anesthesia was maintained with sevoflurane (end-tidal concentration 1.0％-1.7 ％) or propofol TCI (Cp =3-4 μg/ml) in combination with remifentanil TCI (Cp =3.5 ng/ml) and intermittent iv boluses of rocuronium 0.3 mg/kg.BIS was maintained at 40-60 during operation.rSO2 was recorded before induction of anesthesia (T0),10 min before and 10 min after blood vessel was clamped (T1,T2) and 10 min after anastomosis was completed (T3).Results rSO2 was significantly increased on the operated side at T3 in PR group while in SR group bilateral rSO2 was significantly increased at T1-3 as compared with the baseline values at T0 (P ＜ 0.05 or 0.01).rSO2 on the operated side was significantly higher at T1 in group SR than in PR group (P ＜ 0.05).Conclusion The efficacy of sevoflurane-remifentanil anesthesia is similar to that of propofol-remifentanil anesthesia for revascularization for moyamoya disease in terms of maintence of the balance between cerebral oxygen supply and demand.
ABSTRACT
@#Objective To determine the cerebral protective effect of different concentrations of desflurane anesthesia during craniotomy.Methods Twenty two patients, scheduled for selective craniotomy for resections of supratentorial mass lesions, were anesthetized by inhalation of desflurane. When the concentrations of desflurane were maintained at 0.7,1.0 and 1.3 mean alveolar concentration (MAC) for 30 min during removing the tumor, venous blood samples which were drawn through internal jugular bulb were analyzed. Mean arterial pressure (MAP), heart rate (HR), and jugular bulb pressure (JBP) were recorded during the craniotomy.Results Jugular bulb oxygen saturation (SjO2) was significantly declined at 1.0 and 1.3 MAC compared with that at 0.7 MAC (P<0.05 and P<0.01 respectively). There was no significant changes in SjO2 between 1.0 and 1.3 MAC (P>0.05). MAP declined dose dependently, and decreased more significantly at 1.3 MAC (P<0.01).HR and JBP increased slightly with the raising concentration of desflurane but there were no significant changes at any MAC of desflurane (P>0.05).Conclusion Desflurane anesthesia at 1.0 MAC shows cerebral protection effect during craniotomy with stable hemodynamics and improved cerebral oxygen supply and demand.
ABSTRACT
Twenty-two neurosurgical patients were randomly divided into two groups:Group 1 iv drip midazolam and isoflurane inhalation;Group 2 isoflurane inhalation only. The hemodynamic indices and concentration of isoflurane were studied. The results showed that the blood pressure of all the patients were significantly decreased(PMO.01). The concentration of isoflurane in group 1 were .signicantly lowered by 27% than in group 2(P