Jugular bulb venous oxygen saturation during one-lung ventilation under sevoflurane- or propofol-based anesthesia for lung surgery.
OBJECTIVE
During one-lung ventilation (OLV), systemic oxygenation can be compromised. In such a scenario, if anesthetic techniques were used that adversely affected cerebral oxygen balance, the risk for impaired cerebral oxygen balance may be increased. In this study, jugular bulb venous oxygen saturation (SjO(2)) during OLV under sevoflurane- or propofol-based anesthesia for lung surgery was investigated.


METHODS
Prospective clinical study.


METHODS
University hospital.


METHODS
Fifty-two adult patients scheduled for elective thoracic procedures in the lateral position.


METHODS
Patients were randomly allocated to either the sevoflurane or propofol group (n = 26). General anesthesia was maintained with sevoflurane or propofol combined with epidural anesthesia.


RESULTS
Arterial and jugular bulb blood samples were measured before OLV, 15 minutes after OLV, 30 minutes after OLV, and 15 minutes after the termination of OLV. SjO(2) values in both sevoflurane and propofol groups significantly declined during OLV (p < 0.05). SjO(2) values in the sevoflurane group were higher than in the propofol group, although SaO(2) values were similar (p < 0.05). Regarding the incidence of SjO(2) <50% (cerebral oxygen desaturation), there were significant differences between the sevoflurane group and the propofol group during both normally ventilated conditions (0% v 7.7%, p < 0.05, relative risk [RR]: not applicable) and OLV (1.9% v 26.9%, p < 0.05, RR = 14; 95% confidence interval [CI] 1.91-103). Significant increase in the incidence of SjO(2) <50% during OLV was also observed only in the propofol group (from 7.7% to 26.9%, p < 0.05, RR = 3.5; 95% CI 1.29-12.4).


CONCLUSIONS
Cerebral oxygen desaturation was more frequently detected during OLV under propofol- versus sevoflurane-based anesthesia. Cerebral oxygen balance during OLV for lung surgery was less impaired under sevoflurane-based anesthesia compared with propofol; however, the clinical outcome or implications for cognitive function need to be determined.
Iwata
Masato
M
Department of Anesthesiology, Nara Medical University, Nara, Japan.
Inoue
Satoki
S
Kawaguchi
Masahiko
M
Takahama
Makoto
M
Tojo
Takashi
T
Taniguchi
Shigeki
S
Furuya
Hitoshi
H
D000368:Aged; D000767:Anesthesia, Epidural / Q000379:methods; D000768:Anesthesia, General / Q000379:methods; D000777:Anesthetics; D001784:Blood Gas Analysis; D001921:Brain / Q000378:metabolism*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000502:physiology*; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D010100:Oxygen / Q000097:blood* / Q000378:metabolism; D015742:Propofol; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D000077149:Sevoflurane; D019616:Thoracic Surgical Procedures; D013997:Time Factors; D016896:Treatment Outcome
D000777:Anesthetics; D008738:Methyl Ethers; D000077149:Sevoflurane; D010100:Oxygen; D015742:Propofol