Hemodynamic and oxygenation variables during radical cystectomy

ABSTRACT

The effect of anesthetics on hemodynamic variables [HV] has been clarified, but ambiguity existed concerning their effect on oxygenation variables [OV]. Radical cystectomy provided a clinical setting for studying the effect of anesthetics on perioperative HV and OV. Patients subjectd to radical cystectomy [n = 33] were assigned through balanced randomization to receive one of four anesthetic modalities, namely, group I inhalation anesthesia using N[2] OO[2],halothane, d-tubocurarine [n 11]; group II inhalation anesthesia sing N[2] OO[2], halothane, d-tubocurarine, and supplemented with epidural analgesia [EA] [n = 11]; group III total intravenous anesthesia [TIVA] using ketamine 10-30 micro g. kg[-1]. min [-1], propofol 2 mg. kg[-1]. h [-1], d-tubocurarine, and supplemented with continuous EA [n = 6] and group IVTIVA using ketamine 20-50 micro g. kg[-1]. min [-1], midazolam in increments of 1.5 to 5 mg, and supplemented with intermittent EA [n = 5]. Monitoring entailed continuous ECG, pulse oximetry, invasive arterial pressure, and pulmonary artery catheter for HV [HR, MAP, PAP, PAOP, CO, SVR, and PVR] and OV [PaO[2], SaO[2], PvO[2], SvO[2], a-vDO[2], O[2]ext, Q[s]/Q[t], DO[2], and VO[2]]. The heart rate was lower in TIVA while other HV did not show striking differences. Group I showed higher arterial oxygen tension than group II and IV. Mixed venous oxygen tension and saturation were higher in group I over group IV. Other OV did not show remarkable differences. In conclusion, HV and OV in 4 anesthetic modalities did not elicit striking differences