title: Acid-base status and hemodynamic stability during propofol and sevoflurane-based anesthesia in patients undergoing uncomplicated intracranial surgery.
abstract: Propofol anesthesia may induce metabolic disturbances and sevoflurane anesthesia arterial hypotension. This study compares both techniques regarding acid-base and hemodynamic status during intracranial surgery. Sixty-one patients were randomized into 2 groups according to anesthesia maintenance, a propofol group (n=30), and a sevoflurane group (n=31). The anesthesia protocol including rocuronium and remifentanil infusion was otherwise similar in both groups. Arterial blood samples were drawn every 2 hours during the procedure and upon arrival in the intensive care unit to assess acid-base status. The number of hypotensive and hypertensive events served to assess hemodynamic stability. Metabolic acidosis was more frequent during propofol than sevoflurane anesthesia (7 out of 29 and 1 out of 31, P=0.02). Its severity was linearly correlated with lactate concentration (R=0.32), total dose of propofol (R=0.2), and length of procedure (R=0.28). Hyperlactacidemia was also observed during sevoflurane anesthesia, but without acidosis. Hypertension occurred more frequently during propofol than sevoflurane anesthesia (13 out of 30 vs. 1 out of 31, P<0.001), particularly in patients with a past medical history of hypertension. Higher remifentanil infusion rates reduced the risk of hypertension. Conversely, sevoflurane anesthesia favored arterial hypotension (22 out of 31 vs. 12 out of 30, P=0.015). Preoperative morning administration of antihypertensive medications to patients with a history of arterial hypertension was associated with a low probability of hypertensive events, at the cost of more frequent hypotension. In conclusion, propofol anesthesia for intracranial surgery is more frequently associated with lactic acidosis and hypertension; sevoflurane anesthesia may favor arterial hypotension.
authors.affiliation: University Department of Anesthesia and Intensive Care Medicine, CHR de la Citadelle and CHU de Liège, Liege, Belgium. vincent.bonhomme@chu.ulg.ac.be
authors.forename: Vincent
authors.initials: V
authors.lastname: Bonhomme
authors.forename: Jeannick
authors.initials: J
authors.lastname: Demoitie
authors.forename: Isabelle
authors.initials: I
authors.lastname: Schaub
authors.forename: Pol
authors.initials: P
authors.lastname: Hans
mesh_terms: D000136:Acid-Base Equilibrium / Q000502:physiology*; D000140:Acidosis, Lactic; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D001921:Brain / Q000601:surgery*; D003627:Data Interpretation, Statistical; D004562:Electrocardiography; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D019635:Neurosurgical Procedures; D015742:Propofol; D011446:Prospective Studies; D012307:Risk Factors; D000077149:Sevoflurane; D055815:Young Adult
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D015742:Propofol