Hemodynamic and oxygenation variables during radical cystectomy. Does the anesthetic technique really matter?
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.
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
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