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

Purpose: 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 SctO₂ may be an alternative to SjO₂.

Methods: 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.

Results: SjO₂ was 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; r ² = 0.065; p = 0.004) shows a weak relationship between SjO₂ and SctO₂.

Conclusions: Sevoflurane maintains higher SjO₂ levels than propofol during RALP. SctO₂ does not accurately reflect SjO₂.

Keywords: Cerebral oxygenation; Propofol; Robotic-assisted laparoscopic prostatectomy (RALP); Sevoflurane; Steep Trendelenburg position.

Fig. 1

The time courses of jugular venous oxygen saturations (SjO₂) in groups that received sevoflurane (filled circle) and propofol (opened circle). Values are expressed as mean (SD). Multi symbol p < 0.05 vs. group P

Fig. 2

The time courses for regional oxygen saturations (SctO₂) in groups receiving sevoflurane (filled circle) and propofol (opened circle). Values are expressed as mean (SD). *p < 0.05 vs. T0

Fig. 3

Changes in a mean arterial pressure (MAP), b heart rate (HR), c cardiac index (CI), d central venous pressure (CVP), e nasopharyngeal temperature (BT), f Bispectral Index (BIS), g partial pressures of arterial oxygen (PaO₂), h partial pressures of carbon dioxide (PaCO₂), and i hemoglobin concentration (Hb). Measurements were performed: 5 min before the commencement of surgery (T0); 5 min after a 15 mmHg pneumoperitoneum (T1); 5, 30, 60, 90 and 120 min after the Trendelenburg position (T2, T3, T4, T5, and T6, respectively); and after exsufflation in the supine position (T7). Plus symbol p < 0.05 vs. T0 in group S. Hash symbol p < 0.05 vs. T0 in group P. Multi symbol p < 0.05 vs. group P

Fig. 4

Linear regression showing a weak relationship between regional oxygen saturation (SctO₂) and jugular venous oxygen saturation (SjO₂). Data are for 328 measurement pairs from 41 patients