Reference : Acid-base status and hemodynamic stability during propofol and sevoflurane-based anes...
Scientific journals : Article
Human health sciences : Neurology
Human health sciences : Anesthesia & intensive care
http://hdl.handle.net/2268/11322
Acid-base status and hemodynamic stability during propofol and sevoflurane-based anesthesia in patients undergoing uncomplicated intracranial surgery.
English
Bonhomme, Vincent mailto [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 >]
2009
Journal of Neurosurgical Anesthesiology
Lippincott Williams & Wilkins
21
2
112-9
Yes (verified by ORBi)
International
0898-4921
1537-1921
Hagerstown
MD
[en] 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
[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.
http://hdl.handle.net/2268/11322
10.1097/ANA.0b013e3181963471

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