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

Therapeutics and Clinical Risk Management, Oct 2017

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

Therapeutics and Clinical Risk Management Effects of sevoflurane versus propofol on cerebrovascular reactivity to carbon dioxide during laparoscopic surgery Chunyi Wang 1 Cheng n i 1 gang li 1 Yan li 1 liyuan Tao 0 n an li 0 Jun Wang 1 Xiangyang guo 1 0 Research Center of Clinical epidemiology, Peking University Third hospital , Beijing , China 1 Department of anesthesiology 8 1 0 2 - l u J - 2 1 n o 2 7 1 . 3 6 1 . 7 3 . 4 5 y b / m o c . s s e r p e v o d . //www l.yno ladedo ropeF PowerdbyTCPDF(ww.tcpdf.org) - *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 Introduction Cerebrovascular reactivity (CVR) was defined as the ability of small resistance arteries to constrict or dilate following the change of partial pressures of oxygen or partial pressures of carbon dioxide (PaCO2), in which the latter was called CVR to carbon dioxide (CVR-CO ).1 In healthy people, with mean blood pressure (MBP) remaining constant, 2 cerebral blood flow (CBF) increases linearly when PaCO2 increases in a specific range, and a study indicates that each 1 mmHg increase in PaCO2 leads to an average 2%–4% increase in CBF in healthy people.2 Thus, CVR-CO2 could reflect compensatory Therapeutics and Clinical Risk Management 2017:13 1349–1355 1349 © 2017 Wang et al. This work is published and licensed by Dove Medical Press Limited. The ful 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 (http://creativecommons.org/licenses/by-nc/3.0/). 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 (https://www.dovepress.com/terms.php). vasodilation ability of cerebral small vessels,3 which was also known as cerebrovascular reserve capacity. CVR-CO2 decrease was related to many diseases, including cerebrovascular diseases,4–6 Alzheimer’s disease7,8 and hypertension.9 Cerebrovascular disease has correlation with 8 impaired CVR, and a study shows that reduced CVR was l-120 found in patients with lacunar infarct.6 Another study shows -Ju that impaired CVR predicted recurrent symptoms in patients 2 n1 with carotid artery occlusion, and those patients showed a 27o higher risk of recurrent ischemic symptoms.5 In addition, a .631 study in children with a prior diagnosis of transient cerebral .713 arteriopathy showed that impaired CVR was limited to .54 infarct zone and adjacent white matter in most children.4 /yb Studies also indicated that CVR-CO2 declined in people with .com Alzheimer’s disease, which was characterized by impaired rsse cognitive function.7,10,11 Amyloid-beta peptide accumulavpe tion in blood vessels could cause vascular tone dysfunction, o .d which was the main reason of its (...truncated)


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Chunyi Wang, Cheng Ni, Gang Li, Yan Li, Liyuan Tao, Nan Li, Jun Wang, Xiangyang Guo. Effects of sevoflurane versus propofol on cerebrovascular reactivity to carbon dioxide during laparoscopic surgery, Therapeutics and Clinical Risk Management, 2017, pp. 1349-1355, DOI: 10.2147/TCRM.S146272