Jugular Bulb Oxygen Saturation Under Propofol or Sevoflurane/Nitrous Oxide Anesthesia During Deliberate Mild Hypothermia in Neurosurgical Patients

Abstract

Sevoflurane and propofol have been widely used as anesthetic agents for neurosurgery. Recent evidence has suggested that the influence of these anesthetics on cerebral oxygenation may differ. In the present study, the authors investigated jugular bulb oxygen saturation (SjO2) during propofol and sevoflurane/nitrous oxide anesthesia under mildly hypothermic conditions. After institutional approval and informed consent, 20 patients undergoing elective craniotomy were studied. Patients were randomly divided to the group S/N2O (sevoflurane/nitrous oxide/fentanyl anesthesia) or the group P (propofol/fentanyl anesthesia). After induction of anesthesia, the catheter was inserted retrograde into the jugular bulb and SjO2 was analyzed. During the operation, patients were cooled and tympanic membrane temperature was maintained at 34.5 degrees C. SjO2 was measured at normocapnia during mild hypothermia and at hypocapnia during mild hypothermia. There were no statistically significant differences in demographic variables between the groups. During mild hypothermia, SjO2 values were significantly lower in group P than in group S/N2O. The incidence of SjO2 less than 50% under mild hypothermic-hypocapnic conditions was significantly higher in group P than in group S/N2O. These results suggest that hyperventilation should be more cautiously applied during mild hypothermia in patients anesthetized with propofol and fentanyl versus sevoflurane/nitrous oxide/fentanyl.

Cerebral Oxygen Saturation Measured by Near-infrared Spectroscopy and Jugular Venous Bulb Oxygen Saturation during Arthroscopic Shoulder Surgery in Beach Chair Position under Sevoflurane-Nitrous Oxide or Propofol-Remifentanil Anesthesia

“…In the current study, the postinduction baseline SjvO 2 was higher in S/N than in P/R group, being in agreement with previous observations. [15][16][17][18] In addition, the magnitude of decreases in SjvO 2 in BCP was less pronounced (11 Ϯ 10% vs. 23 Ϯ 9%, P ϭ 0.0006) and a reduced SjvO 2 value (less than 50%) was less frequently observed in S/N than in P/R group. Furthermore, the incidence of SjvO 2 less than 40% was null in S/N group as compared with 29% in P/R group (P ϭ 0.0109).…”

“…[12][13][14] Indeed, cerebral oxygen balance is better maintained by sevoflurane-based than by propofol-based anesthesia when patients are positioned supine. [15][16][17][18] In this context, it is also possible that the margin of safety against an impaired cerebral oxygenation would be greater with sevofluranebased than with propofol-based anesthesia in BCP. The choice of anesthetic technique may also influence hemodynamic stability in the sitting position.…”

Intraoperative Secondary Insults During Orthopedic Surgery in Traumatic Brain Injury

“…Secondary insults can occur during any phase of TBI from pre-hospital to the intensive care but the intraoperative period is physiologically distinct. While TBI itself can lead to myocardial and pulmonary dysfunction, 20,21 the anesthetic agents also affect cerebral 22–24 and cardiovascular physiology. 25,26 In addition, surgical intervention leads to fluid shifts and blood loss.…”

Does Hyperventilation Improve Operating Condition During Supratentorial Craniotomy? A Multicenter Randomized Crossover Trial

“…Studies in brain tumor patients have reported a decrease in jugular venous oxygen saturation (SjvO 2 ) after hyperventilation and during additional hypothermia with up to 50% of patients having SjvO 2 Ͻ50%. 16,33,34 Although a previous study demonstrated SjvO 2 values of 40%-45% were associated with metabolic failure and secondary brain damage in headinjured patients, 35 we are uncertain how the ischemic threshold should be applied during anesthesia. It is possible that inadvertent cerebral ischemia may outweigh the benefits of hyperventilation, and should be the subject of further investigation.…”