title: Hemodynamic and oxygenation variables during radical cystectomy. Does the anesthetic technique really matter?
abstract: The effect of anesthetics on hemodynamic variables (HV) has been clarified, but ambiguity existed concerning their effect on oxygenation variables (OV). Radical cystectomy provided a clinical setting for studying the effect of anesthetics on perioperative HV and OV. Patients subjected to radical cystectomy (n = 33) were assigned through balanced randomization to receive one of four anesthetic modalities, namely; group I: inhalation anesthesia using N2O:O2, halothane, d-tubocurarine (n = 11); group II: inhalation anesthesia using N2O:O2, halothane, d-tubocurarine, and supplemented with epidural analgesia (EA) (n = 11); group III: total intravenous anesthesia (TIVA) using ketamine 10-30 ug.kg-1.min-1, propofol 2 mg.kg-1.h-1, d-tubocurarine, and supplemented with continuous EA (n = 6): and group IV:TIVA using ketamine 20-50 ug.kg-1.min-1, midazolam in increments of 1.5 to 5 mg, and supplemented with intermittent EA (n = 5). Monitoring entailed continuous ECG, pulse oximerty, invasive arterial pressure, and pulmonary artery catheter for HV (HR, MAP, PAP, PAOP, CO, SVR, and PVR) and OV. (PaO2, SaO2, PvO2, SvO2, a-vDO2, O2ext, Qs/Qt, DO2, and VO2). The heart rate was lower in TIVA while other HV did not show striking differences, Group I showed higher arterial oxygen tension than group II and IV. Mixed venous oxygen tension and saturation were higher in group I over group IV. Other OV did not show remarkable differences. In conclusion, HV and OV in 4 anesthetic modalities did not elicit striking differences.
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D000778:Anesthetics, Dissociative / Q000008:administration & dosage; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D015653:Cystectomy; D004562:Electrocardiography / Q000187:drug effects; D006221:Halothane / Q000008:administration & dosage; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D009609:Nitrous Oxide / Q000008:administration & dosage; D010092:Oximetry; D010100:Oxygen / Q000097:blood*; D010101:Oxygen Consumption / Q000187:drug effects; D015742:Propofol / Q000008:administration & dosage; D014403:Tubocurarine / Q000008:administration & dosage; D014655:Vascular Resistance / Q000187:drug effects
chemical_list: D000778:Anesthetics, Dissociative; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D003473:Neuromuscular Nondepolarizing Agents; D007649:Ketamine; D009609:Nitrous Oxide; D008874:Midazolam; D010100:Oxygen; D006221:Halothane; D014403:Tubocurarine; D015742:Propofol