title: A comparative analysis of the effects of sevoflurane and propofol on cerebral oxygenation during steep Trendelenburg position and pneumoperitoneum for robotic-assisted laparoscopic prostatectomy.
abstract: Steep Trendelenburg position and pneumoperitoneum during robotic-assisted laparoscopic prostatectomy (RALP) increase intracranial pressure (ICP) and may alter cerebral blood flow (CBF) and oxygenation. Volatile anesthetics and propofol have different effects on ICP, CBF, and cerebral metabolic rate and may have different impact on cerebral oxygenation during RALP. In this study, we measured jugular venous bulb oxygenation (SjO2) and regional oxygen saturation (SctO2) in patients undergoing RALP to evaluate cerebral oxygenation and compared the effects of sevoflurane and propofol. We also verified whether SctO2may be an alternative to SjO2.
  
  
  
  Fifty patients scheduled for RALP were randomly assigned to undergo sevoflurane (group S) or propofol (group P) anesthesia. SjO2, SctO2, mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), central venous pressure (CVP), partial pressures of arterial oxygen (PaO2) and carbon dioxide (PaCO2), hemoglobin concentration (Hb), Bispectral Index (BIS) and nasopharyngeal temperature (BT) were recorded 5 min before surgery commencement, 5 min after pneumoperitoneum, 5, 30, 60, 90, and 120 min after pneumoperitoneum in a Trendelenburg position, and after desufflation in a supine position.
  
  
  
  SjO2was significantly higher in group S than in group P at all measurement points [group S vs. group P: 77 % (11) vs. 65 % (13), mean of all measurement points (1SD); p < 0.01]. Linear regression analysis (β = 0.106; r2= 0.065; p = 0.004) shows a weak relationship between SjO2and SctO2.
  
  
  
  Sevoflurane maintains higher SjO2levels than propofol during RALP. SctO2does not accurately reflect SjO2.
authors: Department of Anesthesiology, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-0023, Japan.
authors: Aya
authors: A
authors: Doe
authors: Department of Anesthesiology, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-0023, Japan. bear@kxd.biglobe.ne.jp.
authors: Motoi
authors: 0000-0003-0578-2198
authors: M
authors: Kumagai
authors: Department of Anesthesiology, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-0023, Japan.
authors: Yuichiro
authors: Y
authors: Tamura
authors: Department of Anesthesiology, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-0023, Japan.
authors: Akira
authors: A
authors: Sakai
authors: Department of Anesthesiology, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-0023, Japan.
authors: Kenji
authors: K
authors: Suzuki
mesh_terms: D000368:Aged; D000758:Anesthesia / Q000379:methods; D001784:Blood Gas Analysis; D002245:Carbon Dioxide / Q000097:blood; D002560:Cerebrovascular Circulation; D018475:Head-Down Tilt / Q000502:physiology; D006801:Humans; D007427:Intracranial Pressure; D007601:Jugular Veins / Q000378:metabolism; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage*; D008875:Middle Aged; D010313:Partial Pressure; D011028:Pneumoperitoneum, Artificial / Q000379:methods; D015742:Propofol / Q000008:administration & dosage*; D011468:Prostatectomy / Q000379:methods*; D065287:Robotic Surgical Procedures / Q000379:methods; D000077149:Sevoflurane
chemical_list: D008738:Methyl Ethers; D002245:Carbon Dioxide; D000077149:Sevoflurane; D015742:Propofol
keywords: Cerebral oxygenation; Propofol; Robotic-assisted laparoscopic prostatectomy (RALP); Sevoflurane; Steep Trendelenburg position