Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 2.1
5-Year Impact Factor – 2.2
Scopus CiteScore – 3.4 (CiteScore Tracker 3.4)
Index Copernicus  – 161.11; MEiN – 140 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2014, vol. 23, nr 6, November-December, p. 919–924

Publication type: original article

Language: English

The Effect of Sevoflurane vs. TIVA on Cerebral Oxygen Saturation During Cardiopulmonary Bypass – Randomized Trial

Çiğdem Y. Güçlü1,A,B,C,D,E,F, Süheyla Ünver1,A,E,F, Bahar Aydınlı1,B,C, Dilek Kazancı1,B,C, Elif Dilber1,B,C, Ayşegül Özgök1,B,C

1 Türkiye Yüksek İhtisas Education and Research Hospital, Clinic of Anesthesia and Reanimation, Ankara, Turkey

Abstract

Background. Neuropsychological and neurological deficits are still major causes of mortality and morbidity after cardiac surgery. These complications are thought to be caused by embolisms and cerebral hypoxia. Thus, continuous neuromonitoring is essential during cardiac surgery due to cerebral oxygen desaturation during different periods. Near-infrared spectrophotometry (NIRS), a non-invasive method, appears to offer many advantages for monitoring cerebral oxygenation and hemodynamics. Desaturation of cerebral oxygen may occur at the beginning of cardiopulmonary bypass (CPB) or during the low perfusion and rewarming stages if not corrected.
Objectives. This study was designed to assess the effects of sevoflurane on cerebral protection during CPB.
Material and Methods. Eighty patients were divided into two groups. Anesthesia was maintained either with fentanyl and midazolam (total intravenous anesthesia, TIVA) or with one minimum alveolar concentration of sevoflurane and fentanyl. Cerebral desaturation was defined as an absolute decrease in saturation of 20% from baseline cerebral saturation. When desaturation occurred, PaCO2, hematocrit and PaO2 levels were checked and corrected. If desaturation continued, anesthetic depth was increased to reserve saturation with 50–100 mg of propofol. NIRS values and hemodynamics were recorded at predetermined time intervals.
Results. Cerebral oxygen saturation values on the right side were higher in the sevoflurane group than in the TIVA group. The values on the left side were higher in the sevoflurane group than in the TIVA group, and meaningful differences were seen at the lowest temperature and at 36°C.
Conclusion. Oxygen saturation was higher in the sevoflurane group than in the TIVA group. Thus, the effect of sevoflurane was useful for maintaining cerebral oxygen saturation during CBP.

Key words

near-infrared spectrophotometry, cerebral oxygen saturation, cardiopulmonary bypass, sevoflurane.

References (26)

  1. Shroyer AL, Coombs LP, Peterson ED, Eiken MC, DeLong ER, Chen A, Ferguson TB Jr, Grover FL: The Society of Thoracic Surgeons: 30-day operative mortality and morbidity risk models. Ann Thorac Surg 2003, 75, 1856–1864.
  2. Uehara T, Tabuchi M, Kozawa S, Mori E: MR angiographic evaluation of carotid and intracranial arteries in Japanese patients scheduled for coronary artery bypass grafting. Cerebrovasc Dis 2001, 11, 341–345.
  3. Yoon BW, Bae HJ, Kang DW, Lee SH, Hong KS, Kim KB, Park BJ, Roh JK: Intracranial cerebral artery disease as a risk factor for central nervous system complications of coronary artery bypass graft surgery. Stroke 2001, 32, 94–99.
  4. Nollert G, Shin’oka T, Jonas RA: Near-infrared spectrophotometry of brain in cardiovascular surgery. Thorac Cardiovasc Surg 1998, 46, 167–175.
  5. Nollert G, Jonas RA, Reichart B: Optimizing cerebral oxygenation during cardiac surgery: A review of experimental and clinical investigations with near infrared spectrophotometry. Thorac Cardiovasc Surg 2000, 48, 247–253.
  6. Edmonds HL, Ganzel BL, Austin EH: Cerebral oximetry for cardiac and vascular surgery. Semin Cardiothorac Vasc Anesth 2004, 8, 147–166.
  7. Murkin JM, Arango M: Near-infrared spectroscopy as an index of brain and tissue oxygenation, Br J of Anaest 2009, 103, Suppl 1, i3–i13.
  8. Edmonds HL Jr: Multi-modality neurophysiologic monitoring for cardiac surgery. Heart Surg Forum 2002, 5, 225–228.
  9. Goldman S, Sutter F, Ferdinand F, Trace C: Optimizing intraoperative cerebral oxygen delivery using noninvasive cerebral oximetry decreases the incidence of stroke for cardiac surgical patients. Heart Surg Forum 2004, 7, 376–381.
  10. Slater JP, Guarino T, Stack J, Vinod K, Bustami RT, Brown JM 3rd, Rodriguez AL, Magovern CJ, Zaubler T, Freundlich K, Parr GV: Cerebral oxygen desaturation predicts cognitive decline and longer hospital stay after cardiac surgery. Ann Thorac Surg 2009, 87, 36–44.
  11. Yao FF, Tseng CA, Ho CA, Levin SK, İllner P: Cerebral oxygen desaturations is associated with early postoperative neuropsychological dysfunction in patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth 2004, 18, 552–58l.
  12. Young WL, Prohovnik I, Correll JW, Ornstein E, Matteo RS, Ostapkovich N: Cerebral bood flow and metabolism in patients undergoing anaesthesia for carotid endarterectomy: a comparison of isoflurane, halothane and fentanyl. Anesth Analg 1999, 68, 712–717.
  13. 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, 364–369.
  14. Malta B, Heath K, Tipping K, Summors AC: Direct cerebral vasodilatory effects of sevoflurane and isoflurane. Anesthesiology 1999, 91, 677.
  15. Gugino LD, Edmonds HL: Neuromonitoring for vascular surgery. Bailliere Clin Anaesthesiol 2000, 14, 17–62.
  16. Lassnigg A, Hismayr M, Keznicki P, Müllner T, Ehrlich M, Grubhofer G: Cerebral oxygenation during cardiopulmonary bypass measured by near-infrared spectroscopy: effects of haemodilution, temperature and flow. J Cardiothorac Vasc Anesth 1999, 13, 544–548.
  17. Harris DN: Cerebral oxygenation during cardiopulmonary bypass. Adv Exp Med Biol 1996, 388, 41–44.
  18. Nollert G, Mohne P, Tassani-Prell P, Reichart B: Determinants of cerebral oxygenation during cardiac surgery. Circulation 1995, 92, 327–333.
  19. Talpahewa SP, Ascione R, Angelini GD, Lovell AT: Cerebral cortical oxygenation changes during OPCAB surgery. Ann Thorac Surg 2003, 76, 1516–1522.
  20. Teng Y, Ding H, Gong Q, Jia Z, Huang L: Monitoring cerebral oxygen saturation during cardiopulmonary bypass sing near-infrared spectroscopy: the relationships with body temperature and perfusion rate. J Biomed Opt 11, 024016 (March/April 2006).
  21. Kadoi Y, Kawahara F, Saito S, Morita T, Kunimoto F, Goto F, Fujita N: Effects of hypotermic and normotermic cardiopulmonary bypass on brain oxygenation. Ann Thorac Surg 1999, 68, 34–39.
  22. Regragui I, Birdİ I, İzzat MB, Black AM, Lopatatzidis A, Day CJ, Gardner F, Bryan AJ, Angelini GD: The effects of cardiopulmonary bypass temperature on neurpsychologic outcome after coronary artery operations: a prospective randomized trial. J Thorac Cardiovasc Surg 1996, 112, 1036–1045.
  23. Martin TD, Craver JM, Gott JP, Weintraub WS, Ramsay J, Mora CT, Guyton RA: Prospective, randomized trial of retrograde warm blood cardioplegia: myocardial benefit and neurological treat. Ann Thorac Surg 1994, 57, 298–302.
  24. Piquette D, Deschamps A, Belisle S, Pellerin M, Levesque S, Tardif JC, Denault AY: Effects of intravenous nitroglycerin on cerebral saturation in high risk cardiac surgery. Can J Anaesth 2007 Sep, 54, 718–727.
  25. Hong SW, Shim JK, Choi YS, Kim DH, Chang BC, Kwak YL: Prediction of cognitive dysfunction and patients’ outcome following valvular heart surgery and the role of cerebral oximetry. Eur J Cardiothorac Surg 2008, 33, 4, 560–565.
  26. Reents W, Muellges W, Franke D, Babin-EbellN J, Elert O: Cerebral oxygen saturation assessed by near-infrared spectroscopy during coronary artery bypass grafting and early postoperative cognitive function. Ann Thorac Surg 2002, 74, 109–114.
© Wroclaw Medical University