The Effect of Nitrous Oxide on Jugular Bulb Oxygen Saturation During Remifentanil Plus Target-Controlled Infusion Propofol or Sevoflurane in Patients with Brain Tumors

Abstract

This study demonstrates that nitrous oxide can increase jugular bulb venous oxygen saturation when added to sevoflurane/remifentanil anesthesia, but not to propofol/remifentanil anesthesia, in patients with brain tumors.

The effect of hypercapnia and hypertension on cerebral oxygen balance during one-lung ventilation for lung surgery during propofol anesthesia

“…The comparison between hypercapnia and MAP may be difficult without measuring CPP. However, we believe that hypercapnia is a better clinical tool to improve cerebral oxygen balance than hypertension, on the basis of the theory that SjO 2 is an indirect index to assess global cerebral oxygen use [7,8,15]. Finally, there might be a concern that the sample size was too small to arrive at this conclusion.…”

“…In our study, a 30% increase in SjO 2 value was noted when hypercapnia was applied. Jugular bulb venous oxygen saturation has been used as an indirect assessment of global cerebral oxygen use to guide physiologic management decisions in a variety of clinical settings [7,8,15]; SjO 2 well reflects the CBF/CMRO 2 (cerebral oxygen supply/ demand) ratio. Thus, the results of our study suggest that the cerebral oxygen supply, which had declined with OLV, was restored to exceed demand by hypercapnia.…”

“…Propofol reduces both cerebral blood flow (CBF) and the cerebral metabolic rate for oxygen (CMRO 2 ) [2][3][4][5][6][7][8], although it appears to have no direct effect on the cerebral vessel tone at clinically relevant concentrations [9]. Several studies have suggested that during propofol anesthesia, the reduction in CBF was larger than the reduction in CMRO 2 , resulting in a decrease in the CBF/ CMRO 2 ratio [6][7][8]. It also has been recognized that possible poor cerebral oxygen balance may occur during propofolbased anesthesia.…”

“…Jugular bulb venous oxygen saturation (SjO 2 ) values have been used indirectly to assess global cerebral oxygen use [7,8,15]. The current study was conducted to determine whether SjO 2 values increased with induced hypercapnia or induced hypertension during propofol-based anesthesia for OLV and whether the frequency of desaturation (SjO 2 b 50%, an early sign of possible poor cerebral oxygen balance [15]) decreased with these interventions.…”

Why we still use intravenous drugs as the basic regimen for neurosurgical anaesthesia

“…In that study, hypocapnia decreased the estimated cerebral perfusion pressure and increased the zero flow pressure under sevoflurane anaesthesia, but did not change those parameters in propofol-anaesthetized patients. The incidence of low jugular venous bulb oxygen saturation has been reported to be higher during propofol than sevoflurane/nitrous oxide anaesthesia and hyperventilation should be more cautiously applied in propofol anaesthetized patients [6,7]. Recent results, however, indicate that increasing propofol concentrations do not affect jugular venous bulb oxygen saturation in neurosurgical patients [8 ].…”