The Comparison of Regional Cerebral Glucose Metabolism Using Positron Emission Tomography during Sevoflurane and Propofol Anesthesia in Human / 대한마취과학회지

BACKGROUND: Recent increases in use of sevoflurane have made active researches on its effects in the cerebral metabolism. However, no specific data on brain glucose metabolism has been reported from human study. We compared the brain glucose metabolism during sevoflurane anesthesia with that of propofol anesthesia using positron emission tomography (PET) in the same human volunteers. METHODS: PET scan was performed two times at intervals of one week in each eight volunteers. One scan was performed in sevoflurane anesthesia, and the other was performed in propofol anesthesia. Each was titrated to the point of unconsciousness. The scan was obtained by the 18fluorodeoxyglucose technique. Relative cerebral glucose metabolic rate (rCMRg) was assessed with statistical parametric mapping. RESULTS: The regions of decreased rCMRg during sevoflurane aneshesia were the visual cortex, posterior parietal association area, primary somatosensory area, and premotor area. During propofol anesthesia the decreased regions were the visual inferotemporal area and prefrontal association area in addition to those area of sevoflurane anesthesia. The increased regions were the partial prefrontal association area, basal ganglia, cingulate, olfactory-limbic cortex, midbrain, and pons during sevoflurane anesthesia, and the primary motor area, insula, thalamus, medulla along with those area of sevoflurane during propofol anesthesia. CONCLUSION: Propofol suppressed the rCMRg of neocortex area more than sevoflurane, and sevoflurane suppressed the rCMRg of paleocortex, telencephalon more than propofol when the unconsciousness level was achieved by anesthesia. Sevoflurane produces different effects on relative brain glucose metabolism with propofol.

Aortic/Radial Arterial Pressure Difference during Weaning from Cardiopulmonary Bypass in Open Heart Surgery Patients Anesthetized with Propofol-Alfentanil / 대한마취과학회지

BACKGROUND: Cardiovascular drugs are frequently used to assist myocardial function after discontinuation of cardiopulmonary bypass (CPB) in the open heart surgery (OHS) because of unstable hemodynamics. At this time we should always consider that the radial arterial pressure (RAP) may be lower than the aortic pressure (AP). In this study we evaluated the difference between AP and RAP in propofol-alfentanil anesthesia. METHODS: 28 patients undergoing elective OHS were randomly allocated into a midazolam-fentanyl (MA) group (n = 14) or a propofol-alfentanil (PA) group (n = 14). Anesthesia in the MF group consisted of midazolam and fentanyl with intermittent bolus injection, and anesthesia in the PA group consisted of propofol and alfentanil with continuous in fusion. RAP and AP in the two groups were recorded for 5 minutes after CPB discontinuation. RESULTS: No significant difference was founded between the two groups in age, weight, height, CPB time, aortic cross clamping (ACC) time, or temperature. There was a relatively high correlation between the difference of systolic AP-RAP and CPB time (r = 0.01), and ACC time (0.001). The systolic and mean blood pressure difference between the aorta and the radial artery in the MF group was significantly greater than in the PA group. CONCLUSIONS: This findings suggest that propofol-alfentanil anesthesia in OHS may be more helpful for hemodynamic management after CPB discontinuation than midazolam-fentanyl anesthesia.