[en] Propofol anesthesia may induce metabolic disturbances and sevoflurane anesthesia arterial hypotension. This study compares both techniques regarding acid-base and hemodynamic status during intracranial surgery. Sixty-one patients were randomized into 2 groups according to anesthesia maintenance, a propofol group (n=30), and a sevoflurane group (n=31). The anesthesia protocol including rocuronium and remifentanil infusion was otherwise similar in both groups. Arterial blood samples were drawn every 2 hours during the procedure and upon arrival in the intensive care unit to assess acid-base status. The number of hypotensive and hypertensive events served to assess hemodynamic stability. Metabolic acidosis was more frequent during propofol than sevoflurane anesthesia (7 out of 29 and 1 out of 31, P=0.02). Its severity was linearly correlated with lactate concentration (R=0.32), total dose of propofol (R=0.2), and length of procedure (R=0.28). Hyperlactacidemia was also observed during sevoflurane anesthesia, but without acidosis. Hypertension occurred more frequently during propofol than sevoflurane anesthesia (13 out of 30 vs. 1 out of 31, P<0.001), particularly in patients with a past medical history of hypertension. Higher remifentanil infusion rates reduced the risk of hypertension. Conversely, sevoflurane anesthesia favored arterial hypotension (22 out of 31 vs. 12 out of 30, P=0.015). Preoperative morning administration of antihypertensive medications to patients with a history of arterial hypertension was associated with a low probability of hypertensive events, at the cost of more frequent hypotension. In conclusion, propofol anesthesia for intracranial surgery is more frequently associated with lactic acidosis and hypertension; sevoflurane anesthesia may favor arterial hypotension.
Disciplines :
Neurology Anesthesia & intensive care
Author, co-author :
Bonhomme, Vincent ; Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation
Demoitie, Jeannick ; Centre Hospitalier Universitaire de Liège - CHU > Soins intensifs
Schaub, Isabelle ; Centre Hospitalier Universitaire de Liège - CHU > Soins intensifs
Hans, Pol ; Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation
Language :
English
Title :
Acid-base status and hemodynamic stability during propofol and sevoflurane-based anesthesia in patients undergoing uncomplicated intracranial surgery.
Publication date :
2009
Journal title :
Journal of Neurosurgical Anesthesiology
ISSN :
0898-4921
eISSN :
1537-1921
Publisher :
Lippincott Williams & Wilkins, Hagerstown, United States - Maryland
Hans P, Bonhomme V. Why we still use intravenous drugs as the basic regimen for neurosurgical anaesthesia. Curr Opin Anaesthesiol. 2006;19:498-503.
Engelhard K, Werner C. Inhalational or intravenous anesthetics for craniotomies? Pro inhalational. Curr Opin Anaesthesiol. 2006; 19: 504-508.
Kam PC, Cardone D. Propofol infusion syndrome. Anaesthesia. 2007;62:690-701.
Bordes J, Meaudre E, Asencio Y, et al. Lactic acidosis associated with propofol during general anaesthesia for neurosurgery. Ann Fr Anesth Reanim. 2008;27:261-264.
Sneyd JR, Andrews CJ, Tsubokawa T. Comparison of propofol/ remifentanil and sevoflurane/remifentanil for maintenance of anaesthesia for elective intracranial surgery. Br J Anaesth. 2005;94: 778-783.
Marsh B, White M, Morton N, et al. Pharmacokinetic model driven infusion of propofol in children. Br J Anaesth. 1991;67:41-48.
Gomes JA, Stevens RD, Lewin JJ III, et al. Glucocorticoid therapy in neurologic critical care. Crit Care Med. 2005;33:1214-1224.
Ginsberg MD. Neuroprotection for ischemic stroke: past, present and future. Neuropharmacology. 2008;55:363-389.
Lysakowski C, Dumont L, Czarnetzki C, et al. Magnesium as an adjuvant to postoperative analgesia: a systematic review of randomized trials. Anesth Analg. 2007;104:1532-1539.
Xiang Z, Bergold PJ. Synaptic depression and neuronal loss in transiently acidic hippocampal slice cultures. Brain Res. 2000;881: 77-87.
Vasile B, Rasulo F, Candiani A, et al. The pathophysiology of propofol infusion syndrome: a simple name for a complex syndrome. Intensive Care Med. 2003;29:1417-1425.
Liolios A, Guerit JM, Scholtes JL, et al. Propofol infusion syndrome associated with short-term large-dose infusion during surgical anesthesia in an adult. Anesth Analg. 2005;100:1804-1806.
Merz TM, Regli B, Rothen HU, et al. Propofol infusion syndrome-a fatal case at a low infusion rate. Anesth Analg. 2006; 103:1050.
Cravens GT, Packer DL, Johnson ME. Incidence of propofol infusion syndrome during noninvasive radiofrequency ablation for atrial flutter or fibrillation. Anesthesiology. 2007;106:1134-1138.
Rozet I, Tontisirin N, Muangman S, et al. Effect of equiosmolar solutions of mannitol versus hypertonic saline on intraoperative brain relaxation and electrolyte balance. Anesthesiology. 2007; 107: 697-704.
Magni G, Baisi F, La RI, et al. No difference in emergence time and early cognitive function between sevoflurane-fentanyl and propofol- remifentanil in patients undergoing craniotomy for supratentorial intracranial surgery. J Neurosurg Anesthesiol. 2005;17:134-138.