Effects of sevoflurane versus propofol on cerebrovascular reactivity to carbon dioxide during laparoscopic surgery
Received 13 July 2017
Accepted for publication 31 August 2017
Published 10 October 2017 Volume 2017:13 Pages 1349—1355
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Professor Deyun Wang
Chunyi Wang,1,* Cheng Ni,1,* Gang Li,1 Yan Li,1 Liyuan Tao,2 Nan Li,2 Jun Wang,1 Xiangyang Guo1
1Department of Anesthesiology, 2Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
*These authors contributed equally to this work
Purpose: Cerebrovascular reactivity to carbon dioxide (CVR-CO2) reflects cerebrovascular reserve capacity, which is important in many brain disorders, including cerebrovascular and Alzheimer’s diseases. Meanwhile, there is a relationship between CVR-CO2 and cognitive function. Therefore, the study is aimed at investigating the effects of sevoflurane versus propofol on CVR-CO2 during laparoscopic surgery, as well as the role of CVR-CO2 on cognitive function during perioperative period.
Patients and methods: Eighty-eight patients, aged 18–65 years undergoing elective laparoscopic cholecystectomy, were randomly assigned to group S and group P. The patients in group S were induced with propofol and maintained with sevoflurane. The patients in group P were induced and maintained with propofol (target-controlled infusion). Remifentanil was given to both groups. CVR-CO2 at baseline (before induction), before pneumoperitoneum and during pneumoperitoneum, as well as Mini-Mental State Examination scores at baseline and 24 hours after surgery were recorded.
Results: In group S, CVR-CO2 before and during pneumoperitoneum increased significantly compared with baseline (P<0.05). In group P, CVR-CO2 before pneumoperitoneum increased significantly (P<0.05), but CVR-CO2 during pneumoperitoneum was not different compared with baseline. In either group, there was no significant correlation between mean blood pressure and CVR-CO2 during surgery, and there was no significant difference between Mini-Mental State Examination scores at baseline and 24 hours after surgery.
Conclusion: Sevoflurane could maintain CVR-CO2 at a higher level during pneumoperitoneum in surgery. Therefore, in patients with impaired cerebrovascular reserve capacity, inhaled anesthetic could be a priority strategy for anesthesia maintenance to improve the compensatory vasodilation ability of cerebral small vessels.
Keywords: cerebrovascular reactivity to carbon dioxide, sevoflurane, propofol, pneumoperitoneum, Mini-Mental State Examination score
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]