Korean J Anesthesiol.  2011 Sep;61(3):225-232. 10.4097/kjae.2011.61.3.225.

The effects of sevoflurane and propofol anesthesia on cerebral oxygenation in gynecological laparoscopic surgery

• Kim SJ
• Kwon JY
• Cho AR
• Kim HK
• Kim TK

• KMID: 2031312
• DOI: http://doi.org/10.4097/kjae.2011.61.3.225

Abstract

BACKGROUND
Both the Trendelenburg position and pneumoperitoneum with carbon dioxide have been reported to increase intracranial pressure (ICP) and to alter cerebral blood flow or cerebral blood volume. Also anesthetic agents have variable effects on cerebral hemodynamics and ICP. The present study was conducted to determine whether regional cerebral oxygen saturation (rSO2) values differ between propofol and sevoflurane anesthesia during laparoscopic surgery in the Trendelenburg position.
METHODS
Thirty-two adult women undergoing gynecological laparoscopic surgery were divided into sevoflurane and propofol groups. rSO2 values were recorded at 10 min after induction in the neutral position (Tpre), 10 min after the pneumoperitoneum in the Trendelenburg position (Tpt) and 10 min after desufflation in the neutral position (Tpost). For analysis of rSO2, we did ANOVA and univariate two-way ANCOVA with covariates being mean arterial pressure and end tidal carbon dioxide tension.
RESULTS
Between sevoflurane and propofol groups, the change in rSO2 was significantly different even after ANCOVA. rSO2 at Tpt (76.3 +/- 5.9% in sevoflurane vs 69.4 +/- 5.8% in propofol) and Tpost (69.5 +/- 7.1% in sevoflurane vs 63.8 +/- 6.6% in propofol) were significantly higher in the sevoflurane group compared with the propofol group. In the propofol group, rSO2 at Tpost was significantly lower than at Tpre (71.1 +/- 4.8%) and cerebral oxygen desaturation occurred in two patients (14.3%).
CONCLUSIONS
Significantly lower rSO2 values were observed in the propofol group during gynecological laparoscopic surgery. The possibility of cerebral oxygen desaturation should not be overlooked during propofol anesthesia even after desufflation of the abdomen in the neutral position.

Keyword

Cerebral hypoxia; Head-down tilt; Near-infrared spectroscopy; Pneumoperitoneum; Propofol; Sevoflurane

MeSH Terms

Abdomen
Adult
Anesthesia
Anesthetics
Antigens, Ly
Arterial Pressure
Blood Volume
Carbon Dioxide
Female
Head-Down Tilt
Hemodynamics
Humans
Hypoxia, Brain
Intracranial Pressure
Isoantigens
Laparoscopy
Methyl Ethers
Oxygen
Pneumoperitoneum
Propofol
Prostaglandins, Synthetic
Spectroscopy, Near-Infrared
Anesthetics
Antigens, Ly
Carbon Dioxide
Isoantigens
Methyl Ethers
Oxygen
Propofol
Prostaglandins, Synthetic