NECMİYE HADİMİOĞLU, Aydoğdu Tülin TİTİZ, M. Levent DÖŞEMECİ, Tanju UÇAR, Meliha ERMAN

Kranyotomi olgularında sevofluran ve propofolün jugular bulb oksijen satürasyonu ve hemodinami üzerine olan etkilerinin karşılaştırılması

Bu çalışmada, beyin tümörü nedeniyle kranyotomi yapılan ASA l-ll grubu olgularda propofol ve sevofluranın beyin ekartasyonu, tümör çıkarılması ve ekstübasyon dönemlerinde jugular bulb oksijen basıncı ve satürasyonu, arteriyovenöz oksijen içerik farkı ve hemodinami üzerine olan etkileri incelendi. 24 olgu randomize edildikten sonra anestezi indüksiyonu I. grupta propofol, fentanil, vekuronyum (grup P), II. grupta tiyopental, sevofluran, fentanil ve vekuronyum ile (grup S) sağlandı. Endotrakeal entübasyonu takiben anestezi P grubunda 6 mg kg-1 propofol, % 50-50 O2-N2O ile S grubunda 1-1.5 MAC değerinde sevofluran, % 50 - 50 O2-N2O ile idame ettirildi. Her iki gruba gerektiği zaman f entanil ve vekuronyum ilaveleri yapıldı. Jugular bulb venöz oksijen satürasyonu beyin ekartasyonu sırasında P grubunda % 67 ± 14, S grubunda % 66.8 ± 9.5, tümör çıkarılması döneminde P grubunda % 66.2 ± 12.9, S grubunda % 69.l±15.6, ekstübasyondan sonra ise P grubunda % 75.7 ± 7.4, S grubunda % 74.1 ± 11.3 olarak saptandı ve bu değişkenlerde gruplar arasında anlamlı farklılık bulunmadı (p>0.05). Arteriyovenöz oksijen içerik farkı ve hemodinamik veriler açısından da bu dönemlerde gruplar arasında farklılık saptanmadı (p>0.05). Sonuç olarak beyin tümörü nedeniyle kranyotomi yapılan olgularda propofol ve sevofluranın beyin ekartasyonu, tümör çıkarılması ve ekstübasyon dönemlerinde jugular bulb oksijen satürasyonu, arteriyovenöz oksijen içerik farkı ve hemodinami üzerine olan etkilerinin benzer olduğu sonucuna varıldı.

Anahtar Kelimeler:

Kraniyotomi, Propofol, Anestezikler, inhalasyon, Beyin neoplazmları

Comparison of the effects of propofol and sevoflurane on jugular bulb oxygen saturation and hemodynamics in patients undergoing craniotomy

In this study, we investigated the effects of propofol and sevoflurane on venous oxygen partial pressure and hemoglobin saturation of jugular bulb, arterial to jugular bulb venous oxygen content difference and hemodynamic parameters during brain retraction, tumor removal and extubation in ASA I to II patients undergoing craniotomyfor brain tumor surgery. Patients were randomly divided into two groups as propofol and sevoflurane. In the propofol group (group P); anesthesia was induced with propofol, fentanyl and vecuronium. In sevoflurane group (group S); thiopental, sevoflurane, fentanyl and vecuronium were used for induction. After endotracheal intubation in group P, anesthesia was maintained with 6 mg kg'1 propofol O2-N2O 50-50 %. In group S, anesthesia was maintained with MAC 1-1.5 sevoflurane and O2-N2O 50-50 %. When it was necessary fentanyl and vecuronium were added in two groups. Mean jugular bulb oxygen saturation were 67 % ±14 in group P, 66.8 % ± 9.5 in group S during brain retraction, 66.2 % ± 12.9 in group P, 69.1 % ± 15.6 in group S during tumour removal, 75.7 % ± 7.4 in group P, 74.1 % ±11.3 in S group during extubation. There were no significant differences between the groups at these stage (p>0.05). Mean arterial to jugular bulb venous oxygen content difference and hemodynamic parameters did not show significant differences between the groups (p>0.05). In conclusion, the effects of sevoflurane and propofol on jugular bulb oxygen saturation and mean arterial to jugular bulb venous oxygen content and on hemodynamic variable were similar during brain retraction, tumour removal and extubation.

Keywords:

Craniotomy, Propofol, Anesthetics, Inhalation, Brain Neoplasms,

PDF

___

1. Hemelrijck JV,Aken HV, Plets Ch, Goffin J, Vermaut G: The effects of propofol on intracranial pressure and cerebral perfusion pressure in patients with brain tumors. Acta Anesth Belg 1989; 40: 95-100.
2. Ravussin P, Tempelhoff R, Modica PA, Bayer-berger MM: Propofol vs. thiopental-isoflurane for neurosurgical anesthesia: comparison of hemodynamics, CSF pressure, and recovery. J Neurosurg Anesthesiol 1991; 3: 85-95.
3. Takahashi H, Murata K, Ikeda K. Sevoflurane does not increase intracranial pressure in hyperventilated dogs. B J Anaesth 1993; 71:551-5.
4. Scheller MS, Tateishi A, Drummond JC, Zornow MH. The effects of sevoflurane on cerebral blood flow, cerebral metabolic rate for oxygen, intracranial pressure, and the electroencephalogram are similar to those of isoflurane in the rabbit. Anesthesiology 1988; 68: 548-51.
5. Lenz C, Rebel A, Ackern KV, Kuschinsky W, Waschke KF. Local cerebral blood flow, local cerebral glucose utilization, and flow-metabolism coupling during sevoflurane versus isoflurane anesthesia in rats. Anesthesiol Clin North Am 1998; 16: 1480-95.
6. Kitaguchi K, Ohsumi H, Kuro M, Nakajima T, Hayashi Y. Effects of sevoflurane on cerebral circulation and metabolism in patients with ischemic cerebrovascular disease. Anesthesiology 1993; 79: 704-9.
7. Gupta S, Heath K, Matta BF. Effect of incremental doses of sevoflurane on cerebral pressure autoregulation in humans. Br J Anaesth 1997; 79: 469-72.
8. Summors AC, Gupta AK, Matta BF. Dynamic cerebral autoregulation during sevoflurane anesthesia: a comparison with isoflurane. Anesth Analg 1999; 88: 341-6.
9. Bungaard H, Von Oettingen G, Larsen KM, et al. Effects of sevoflurane on intracranial pressure, cerebral blood flow and cerebral metabolism. A dose-response study in patients subjected to craniotomy for cerebral tumours. Acta Anaesthesiol Scand 1998; 42: 621-8.
10. Matta BF, Heath KJ, Summors AC. Direct cerebral vasodilatory effects of sevoflurane and isoflurane. Anesthesiology 1999; 91: 677-80.
11. Cruz J. The first decade of continuous monitoring of jugular bulb oxyhemoglobin saturation: Management strategies and clinical outcome. Crit Care Med 1998; 26: 344-51.
12. Lam AM, Mayberg TS. Anesthesia for the patient with neurologic disease. Jugular bulb venous oximetry monitoring. Anesthesiol Clin North Am 1997; 15: 533-49.
13. Feldman Z, Robertson CS. Update on neurologic critical care. Monitoring of cerebral hemodynamics with catheters. Crit Care Med 1997; 13: 51-6.
14. Jansen GEA, Praagh BHV, Kedaria MB, Odoom JA. Jugular bulb oxygen saturation during propofol and isoflurane/nitrous oxide anesthesia in patients undergoing brain tumor surgery. Anesth Analg 1999; 89: 358-63.
15. Mielck F, Stephan H, Weyland A, Sonntag H. Effects of one minimum alveolar anesthetic concentration sevoflurane on cerebral metabolism, blood flow, and CO2 reactivity in cardiac patients. Anesth Analg 1999; 89: 364-70.
16. Artru AA, Lam AM, Johnson JO, Sperry RJ. Intracranial pressure, middle cerebral artery flow velocity, and plasma inorganic fluoride concentrations in neurosurgical patients receiving sevoflurane or isoflurane. Anesth Analg 1997; 85: 587-92.
17. Munoz HR, Nunez G, De La Fuente J Campos MG.The effect of nitrous on jugular bulb oxygen saturation during remifentanil plus target-controlled infusion propofol or sevoflurane in patients with brain tumors. Anesth Analg 2002; 94: 389-92.
18. Bullock R, Stewart L, Rafferty C, Teasdale GM. Continuous monitoring of jugular bulb oxygen saturation and the effect of drugs acting on cerebral metabolism. Acta Neurochir 1993; 5: 113-8.