The Effect of Desflurane and Sevoflurane on Cerebral Oximetry Under Steady-State Conditions

Abstract

We studied the effect of sevoflurane and desflurane on regional cerebral oxygenation (rSO2). Twenty-two patients undergoing abdominal hysterectomy received sevoflurane and desflurane for 15 min each and 30 min apart under steady-state conditions in a randomized, crossover manner to maintain a bispectral index (BIS) of 40-50. In another 22 patients undergoing the same anesthesia and surgery BIS was maintained at 20-30. During the 15-min administration of each anesthetic at steady-state conditions rSO2, BIS, inspired and end-tidal anesthetic concentrations, end-tidal CO2, Spo2, systolic and diastolic blood pressures, and heart rate were recorded every 3 min. The rSO2 did not differ between sevoflurane and desflurane when BIS values were maintained between 40-50 or 20-30. The MAC(BIS) values required to maintain BIS at 40-50 and at 20-30 were 1.0 versus 1.2 (P = 0.004) and 1.6 versus 1.8 (P < 0.001) for desflurane and sevoflurane respectively. Higher rSO2 values were obtained by 1.6 MAC (71 +/- 13) than by 1 MAC of desflurane (66 +/- 10; P < 0.001) and by 1.8 MAC (72 +/- 11) than by 1.2 MAC of sevoflurane (66 +/- 13; P < 0.001). In conclusion, equipotent concentrations of desflurane or sevoflurane in terms of BIS are associated with similar rSO2 values, but larger anesthetic concentrations of both anesthetics increased the rSO2 values.

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

“…43 Moreover, cerebral oximetry values may be affected by depth of anesthesia, the type of anesthetic administered, arterial carbon dioxideconcentrations, inspired oxygen content, and systemic blood pressure management. 44,45 In the current study, the mean ( fig. 7).…”

Influence of Ventilation Strategies and Anesthetic Techniques on Regional Cerebral Oximetry in the Beach Chair Position

“…35 Near infrared light penetrates the grey matter by a few millimeters 36 and therefore oxygenation is measured only in the superficial cortex. Cerebral oximetry values are impacted by systemic blood pressure, 37 sensor location, 38 anesthetic depth for vapor-based anesthetic techniques 39 and hematocrit. 38 The cerebral a:v ratio is assumed constant within device algorithms and therefore rSO 2 can vary without a true change in cerebral oxygenation.…”

The influence of basic ventilation strategies and anesthetic techniques on cerebral oxygenation in the beach chair position: study protocol

“…The decrease in CMRO 2 and cerebral vasodilation are greater with desflurane when compared to other inhalational agents [15]. Regional oximetry values increase in supine patients with increasing anesthetic depth of desflurane [24] and cerebral desaturation is more frequently observed during one lung ventilation while using TIVA with propofol compared to inhalational anesthesia [14]. Cerebral oxygenation is reported to be better preserved with sevoflurane-nitrous oxide anesthesia when compared to propofol-remifentanil anesthesia for patients placed in beach chair position [22], but nitrous oxide and remifentanil may have acted as uncontrolled confounding factors.…”