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Effects of sevoflurane versus propofol on cerebrovascular reactivity to carbon dioxide during laparoscopic surgery

Authors Wang C, Ni C, Li G, Li Y, Tao L, Li N, Wang J, Guo X

Received 13 July 2017

Accepted for publication 31 August 2017

Published 10 October 2017 Volume 2017:13 Pages 1349—1355

DOI https://doi.org/10.2147/TCRM.S146272

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

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

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