Comparison of Effects on Intraoperative Cerebral Metabolism between Total Intravenous Anesthesia and Intravenous Inhalation Anesthesia in Patients in Neurosurgery

Objective To compare the effect on intraoperative cerebral metabolism between the propofol combined with remifentanil infusion in total intravenous anesthesia and the desflurane combined with remifentanil intravenous inhalation anesthesia in patients in neurosurgery.Methods Thirty-four patients were randomly divided into the propofol combined with remifentanil group(group A,n=16) and the desflurane combined withremifentanil group(group B,n=18).The B-ultrasound under the guide of retrograde catheterization through right internal jugular vein and artery was prepared after the patients entered the operation room.Atropine,propofol,fentanyl, rocuronium were used in the induction of anesthesia.The mechanical ventilation was applied after conventional trachea cannula.Once patients were anesthetized steadily, jugular bulb venous oxygen saturation(Sjv O),jugular2 bulb venous oxygen partial pressure(Pjv O),Jugular2 Bulb venous hemoglogin(Hbv),jugular bulb venous lactate(Ljv),jugular bulb venous gluxose(Gv),arterial oxygen saturation(Sa O),arterial2 oxygen pressure(Pa O2),arterin(Hba),arterial blood lactate(La),arterial blood gluxose(Ga),arterial blood oxygen content(Ca O2), jugular bulb venous oxygen content(Cjv O2), arteriovenous oxygen difference(AVDO2),cerebral extraction of oxygen(CEO2),cerebral lactate production rate(CLP) and cerebral glucose uptake rate(CGU) at different time [before anesthesia induction(T1),1 hours after the start of the operation(T2),2 hours after the start of the operation(T3),half an hour after the operation]were collected.Results(1) The value of Sjv O2,Pjv O2,Cjv O2 and Ca O2 in group B was significantly higher than that in group A(P<0.001);The value of AVDO2 and CEO2in group B was lower than that in group A(P<0.05);(2) The value of Gv and Ga in group B was higher than that in group A(P<0.05);There were no significant differences about CGU in two groups(P>0.05);(3) The value of CLP in group B was lower than that in group A(P<0.05);there were no significant differences about Ljv and La in two groups(P>0.05);(4) Compared with the value at moment of T1 between group A and group B,the value of Pa O2,Sa O2,Pjv O2 and Sjv O2 were increased with time(P<0.05),the value of Ca O2, Cjv O2, AVDO2 and CEO2showed a downward trend(P <0.05).Conclusion(1) Both total intravenous anesthesia and intravenous inhalation anesthesia can reduce the cerebral oxygen metabolism;(2) For the cerebral protection of neurosurgery operation,it seems that the effect of intravenous inhalation anesthesia is more stronger than total intravenous anesthesia.