Ružman Tomislav, Šimurina Tatjana, Gulam Danijela, Ružman Nataša, Miškulin Maja
Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Osijek, J. Huttlera 4, Osijek, Croatia; Faculty of Medicine, University of Osijek, Cara Hadrijana 10, Osijek, Croatia; Our Lady of Lourdes Hospital Drogheda, Boyle O'Reilly Terrace, Drogheda, Co Louth, Ireland.
Department of Anesthesiology and ICU, General Hospital Zadar, Bože Peričića 5, Zadar,Croatia; Faculty of Medicine, University of Osijek, Cara Hadrijana 10, Osijek, Croatia; Department of Health Study, University of Zadar, Mihovila Pavlinovića 1, Zadar, Croatia.
J Clin Anesth. 2017 Feb;36:110-117. doi: 10.1016/j.jclinane.2016.10.010. Epub 2016 Dec 1.
To investigate possible effects of volatile induction and maintenance anesthesia with sevoflurane (VIMA) and total intravenous anesthesia with propofol (TIVA) on regional cerebral oxygen saturation (rcSo) during laparoscopic cholecystectomy.
Randomized, prospective and single-blinded study.
Academic hospital.
ASA physical status of I and II surgical patients, scheduled for elective laparoscopic cholecystectomy from March 2013 to October 2014.
Changes of regional cerebral oxygen saturation were measured by near-infrared spectroscopy on the left and right sides of forehead at different time points: before anesthesia induction (Tbas), immediately after induction (Tind), after applaying a pneumoperitoneum (TCo), 10 minutes after positioning the patient into reverse Trendelenburg's position (TrtCo), immediately after desufflation of gas (Tpost) and 30 (Trec30) and 60 (Trec60) minutes after emergence from anesthesia.
Study population included 124 patients, 62 in each group. There was no significant difference between these groups according to demographic characteristics, surgery and anesthesia times as well as in the basal rcSo values. Statistically higher rSco values were noted in the VIMA group when compared to the TIVA group in all time points Tind, TCo, TrtCo, Tpost, Trec30 and Trec60 and incidence of critical rcSo decreases was statistically lower in VIMA group (P<.05). There were no serious perioperative complications.
VIMA technique provides significantly (4%-11%) higher rcSO values during general anesthesia for laparoscopic cholecystectomy, when compared with TIVA and also provides significantly less number of critical rcSO decreases.
探讨七氟醚挥发性诱导维持麻醉（VIMA）和丙泊酚全静脉麻醉（TIVA）对腹腔镜胆囊切除术期间局部脑氧饱和度（rcSo）的可能影响。
随机、前瞻性单盲研究。
教学医院。
2013年3月至2014年10月计划行择期腹腔镜胆囊切除术的ASA I级和II级外科患者。
在不同时间点通过近红外光谱法测量前额左右两侧局部脑氧饱和度的变化：麻醉诱导前（Tbas）、诱导后即刻（Tind）、气腹后（TCo）、患者置于头低脚高位10分钟后（TrtCo）、气体放气后即刻（Tpost）以及麻醉苏醒后30分钟（Trec30）和60分钟（Trec60）。
研究人群包括124例患者，每组62例。根据人口统计学特征、手术和麻醉时间以及基础rcSo值，两组之间无显著差异。在所有时间点Tind、TCo、TrtCo、Tpost、Trec30和Trec60，VIMA组的rSco值在统计学上高于TIVA组，并且VIMA组rcSo严重降低的发生率在统计学上更低（P<0.05）。围手术期无严重并发症。
与TIVA相比，VIMA技术在腹腔镜胆囊切除术全身麻醉期间可使rcSO值显著提高（4%-11%），并且rcSO严重降低的次数也显著减少。
