Effects of sevoflurane versus propofol on cerebral autoregulation during anaesthesia for robot-assisted laparoscopic prostatectomy

被引:5
作者
Robertson, Tomas J. [1 ]
McCulloch, Timothy J. [1 ,2 ]
Paleologos, Michael S. [1 ,2 ]
Downey, Ryan G. [1 ,2 ]
Loadsman, John A. [1 ,2 ]
Thanigasalam, Ruban [1 ,3 ,4 ]
Leslie, Scott [1 ,3 ,4 ]
机构
[1] Univ Sydney, Sydney Med Sch, Sydney, NSW, Australia
[2] Royal Prince Alfred Hosp, Dept Anaesthet, Camperdown, NSW 2050, Australia
[3] Chris OBrien Lifehouse, Dept Urol, Camperdown, NSW, Australia
[4] Inst Acad Surg, Royal Prince Alfred Hosp, Camperdown, NSW, Australia
关键词
Robotic surgical procedures; head-down tilt; propofol; sevoflurane; cerebrovascular circulation; PRESSURE AUTOREGULATION; TRENDELENBURG POSITION; BLOOD-FLOW; REMIFENTANIL; SURGERY; ISOFLURANE; ARTERIAL; TUMORS;
D O I
10.1177/0310057X211061158
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Robot-assisted laparoscopic prostatectomy requires a pneumoperitoneum combined with steep Trendelenburg positioning, and these conditions can be associated with impairment of cerebral autoregulation. The objective of this study was to determine if choice of anaesthetic agent affects the preservation of cerebral autoregulation during robot-assisted laparoscopic prostatectomy. We randomly assigned 30 patients to maintenance of general anaesthesia with either propofol or sevoflurane. Cerebral autoregulation was tested by administration of intravenous phenylephrine to increase mean arterial pressure from approximately 80 mmHg to 100 mmHg while assessing cerebral blood flow using transcranial Doppler ultrasonography. Autoregulation was first tested in the supine position and then approximately once every hour after Trendelenburg positioning. The main outcome measure was the result of the final autoregulation test prior to completion of surgery. At that time, we found cerebral autoregulation to be significantly impaired in six of the 15 patients receiving sevoflurane and none of the 15 patients receiving propofol (P = 0.02). However, it should be noted that some patients in the propofol group had impaired autoregulation on earlier tests. In conclusion, we found that autoregulation during robot-assisted laparoscopic prostatectomy is less likely to be impaired with propofol compared to sevoflurane anaesthesia, particularly towards the end of the surgery.
引用
收藏
页码:361 / 367
页数:7
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