Article (Scientific journals)
Acid-base status and hemodynamic stability during propofol and sevoflurane-based anesthesia in patients undergoing uncomplicated intracranial surgery.
Bonhomme, Vincent; Demoitie, Jeannick; Schaub, Isabelle et al.
2009In Journal of Neurosurgical Anesthesiology, 21 (2), p. 112-9
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Keywords :
Acid-Base Equilibrium/physiology; Acidosis, Lactic; Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia, General; Anesthetics, Inhalation; Anesthetics, Intravenous; Brain/surgery; Data Interpretation, Statistical; Electrocardiography; Female; Hemodynamics/physiology; Humans; Male; Methyl Ethers; Middle Aged; Neurosurgical Procedures; Propofol; Prospective Studies; Risk Factors; Young Adult
Abstract :
[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
Volume :
21
Issue :
2
Pages :
112-9
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 21 January 2010

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