Anesthesiology and Reanimation Department, Health Sciences University, Ankara City Hospital, Ankara, Turkey.
Eur Rev Med Pharmacol Sci. 2022 Jun;26(12):4279-4288. doi: 10.26355/eurrev_202206_29066.
The aim of this study is to evaluate the effect of total intravenous anesthesia (TIVA) and inhalational anesthesia techniques on tissue oxygenation in cardiac surgery. We compared the effects of midazolam-based TIVA and sevoflurane-based (SEVO) inhalation anesthesia maintenance on intraoperative central and regional tissue oxygenation parameters.
A total of 104 adult patients who were scheduled for elective isolated coronary bypass surgery were included in the study. All patients were divided into two groups: the TIVA group consisted of total intravenous anesthesia maintenance patients (n=52) and the SEVO group consisted of patients with inhalation anesthesia with sevoflurane maintenance (n=52). Tissue oxygenation values were observed with left-right cerebral and somatic left forearm Near-Infrared Spectroscopy (NIRS) sensors. The hemodynamic parameters, NIRS StO2, central (ScvO2) and peripheral venous oxygen saturations of the patients were recorded at six intraoperative time points.
The effects of midazolam-based TIVA and sevoflurane-based inhalation anesthesia maintenance on intraoperative central and peripheral tissue oxygenation parameters were compared and it was found that in the left forearm NIRS StO2 and ScvO2 values were higher in the SEVO group than the TIVA group. Although not significantly different, forearm regional venous oxygen saturation was also higher in the SEVO group.
The effects of anesthetic drugs on regional tissue oxygenation can become important in critical patients and challenging surgeries. Sevoflurane-based anesthesia provides better tissue oxygenation than TIVA in patients undergoing coronary bypass surgery.
本研究旨在评估全凭静脉麻醉（TIVA）和吸入麻醉技术对心脏手术组织氧合的影响。我们比较了咪达唑仑为基础的 TIVA 和七氟醚为基础的（SEVO）吸入麻醉维持对术中中心和区域组织氧合参数的影响。
共纳入 104 例择期行单纯冠状动脉旁路移植术的成年患者。所有患者分为两组：TIVA 组为全静脉麻醉维持患者（n=52），SEVO 组为吸入麻醉七氟醚维持患者（n=52）。使用左右大脑和躯体左前臂近红外光谱（NIRS）传感器观察组织氧合值。记录患者 6 个术中时间点的血流动力学参数、NIRS StO2、中心（ScvO2）和外周静脉氧饱和度。
比较了咪达唑仑为基础的 TIVA 和七氟醚为基础的吸入麻醉维持对术中中心和外周组织氧合参数的影响，发现 SEVO 组患者左前臂 NIRS StO2 和 ScvO2 值高于 TIVA 组。虽然差异不显著，但 SEVO 组前臂区域静脉氧饱和度也较高。
麻醉药物对局部组织氧合的影响在危重症患者和挑战性手术中可能变得重要。与 TIVA 相比，七氟醚为基础的麻醉在接受冠状动脉旁路移植术的患者中提供更好的组织氧合。
