Department of Anesthesiology and Pain Medicine, Anesthesiology and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
J Clin Monit Comput. 2014 Aug;28(4):371-6. doi: 10.1007/s10877-013-9543-5. Epub 2013 Dec 12.
The sitting position may cause significant hemodynamic instability and cerebral hypoperfusion. We investigated the effects of desflurane and propofol on regional cerebral oxygenation (rSO2) in the sitting position during arthroscopic shoulder surgery. Forty patients undergoing arthroscopic shoulder surgery in the sitting position were randomly allocated to the desflurane group (n = 20) or the propofol group (n = 20). Anesthetic agents were maintained and adjusted with the effect-site concentration of propofol (2-3.5 μg/ml) or desflurane (4-7 vol%) to obtain a bispectral index (BIS) of 40-50. The hemodynamic variables, end-tidal carbon dioxide tension (ETCO2) and rSO2 were measured and evaluated. There were no differences in BIS, hemodynamic variables and ETCO2 between the groups. The rSO2 values in the desflurane group were higher compared to the propofol group at 3, 5, 7 and 9 min after the sitting position (P = 0.031, 0.047, 0.025 and 0.034, respectively). However, it decreased significantly from the baseline values at 3, 5, 7 and 9 min after the sitting position in both groups (P < 0.001). The change in rSO2 across time was not significantly different between the groups (P = 0.183). The incidence of rSO2 <75% of the baseline values after the sitting position was similar between the groups (0 and 10% in the desflurane and propofol group, respectively, P = 0.487). When anesthetized patients were raised to the sitting position, desflurane preserved cerebral oxygenation better than propofol at equipotent concentrations in terms of BIS. However, both anesthetics were associated with significant decrease in the rSO2 values during the sitting position.
坐位可能导致显著的血液动力学不稳定和脑灌注不足。我们研究了七氟醚和丙泊酚对关节镜肩关节手术坐位时局部脑氧合（rSO2）的影响。40 例在坐位下行关节镜肩关节手术的患者被随机分配到七氟醚组（n = 20）或丙泊酚组（n = 20）。用丙泊酚（2-3.5μg/ml）或七氟醚（4-7 体积%）的效应部位浓度维持和调整麻醉剂，以获得 40-50 的双频谱指数（BIS）。测量并评估血流动力学变量、呼气末二氧化碳分压（ETCO2）和 rSO2。两组间 BIS、血流动力学变量和 ETCO2 无差异。坐位后 3、5、7 和 9 分钟，七氟醚组 rSO2 值高于丙泊酚组（P = 0.031、0.047、0.025 和 0.034）。然而，两组 rSO2 值均较基础值显著降低（P < 0.001）。坐位后 rSO2 随时间的变化在两组间无显著差异（P = 0.183）。坐位后 rSO2 <基础值 75%的发生率在两组间相似（七氟醚组为 0%，丙泊酚组为 10%，P = 0.487）。当麻醉患者被抬高至坐位时，七氟醚在与丙泊酚等效浓度时在保持脑氧合方面优于丙泊酚。然而，两种麻醉药在坐位时均显著降低 rSO2 值。
