RESUMEN
Objective:To study cerebral oxygen metabolism and cerebral blood flow in etomidate and sevoflurane anesthesia effects of perfusion and postoperative delusions.Methods:A prospective study was used. The 96 elderly patients who underwent elective spinal surgery in Guang′anmen Hospital, China Academy of Chinese Medical Sciences from March 2020 to May 2021 were selected as the study subjects. All patients were divided into sevoflurane group and etomidide group by random numbers table, each with 48 cases. The sevoflurane group was treated with sevoflurane inhalation for analgesia, with etomidate intravenous-controlled analgesia in the etomidate group. The recovery time of spontaneous respiratory, wake time, awake extubation time, numerical rating score (NRS; 1, 3, 6, 12, 24 and 48 h), incidence of postoperative delusion, internal jugular vein oxygen saturation (SjvO 2) were recorded. Arteriovenous oxygen content (AVDO 2) and cerebral oxygen intake rate (CERO 2) were calculated. The peak cerebral artery constriction rate (Vs-MCA), diastolic velocity (Vd-MCA) and mean flow rate (Vm-MCA) pre-induction of anesthesia (T 0), loss of consciousness (T 1), after fentanyl injection (T 3), endotracheal intubation (T 4), 30 min (T 5), 60 min (T 6) and postoperative (T 7) were recorded. Results:There were no significant differences in the recovery time of spontaneous breathing, wake time and awake extubation time between the two groups ( P>0.05). The resting NRS in sevoflurane group at 1, 3, 6, 12, 24 and 48 h after operation were (1.27 ± 0.12), (2.13 ± 0.22), (3.26 ± 0.23), (3.29 ± 0.22), (2.52 ± 0.11) and (2.02 ± 0.11) points, respectively. Etomidate group was (1.27 ± 0.13), (2.02 ± 0.21), (2.13 ± 0.13), (2.11 ± 0.26), (2.08 ± 0.17) and (1.02 ± 0.17) points, respectively. The results of repeated measurement ANOVA showed that there was significant difference in NRS between the two groups ( P<0.05). There were significant differences in postoperative resting NRS between the two groups at different time points ( P<0.05). The incidence of postoperative delusion in etomidate group was lower than that in sevoflurane group: 4.17% (2/48) vs. 16.67% (8/48), and the difference was statistically significant ( P<0.05). Postoperative SjvO 2 in sevoflurane group and etomidate group was higher than that before surgery: (69.96 ± 4.17)% vs. (58.26 ± 4.16)%, (61.22 ± 4.19)% vs. (58.25 ± 4.17)%. In addition, both AVDO 2 and CERO 2 were lower than those before operation: (60.23 ± 5.22)% vs. (64.22 ± 4.17)%, (50.23 ± 6.19)% vs. (64.23 ± 4.19)%, (37.22 ± 6.23)% vs. (40.23 ± 5.16)%, (31.26 ± 5.17)% vs. (40.27 ± 4.18)% ( P<0.05), postoperative SjvO 2 in etomidate group was higher than that in sevoflurane group, and AVDO 2 and CERO 2 were lower than that in sevoflurane group. The difference was statistically significant ( P<0.05). The results of repeated measurement ANOVA showed that there were statistically significant differences in cerebral blood perfusion indexes of Vs-MCA, Vd-MCA and Vm-MCA between the two groups ( P<0.05). There were statistically significant differences in Vs-MCA, Vd-MCA and Vm-MCA between two groups at different time points ( P<0.05). There were significant differences in Vs-MCA, Vd-MCA and Vm-MCA between the two groups at different time points ( P<0.05). Conclusions:Compared with sevoflurane, etomidate can reduce the postoperative delusion rate, improve cerebral oxygen metabolism and reduce cerebral blood flow perfusion.