Changes in cerebral oxygen delivery/consumption and glucose metabolism during laparoscopic gynecologic surgery under propofol-fentanyl anesthesia
- VernacularTitle:异丙酚-芬太尼麻醉下妇科腹腔镜手术患者脑葡萄糖与氧代谢的变化
- Author:
Shiyuan XU
;
Jingli HOU
;
Ping XU
- Publication Type:Journal Article
- Keywords:
Propofol;
Laparoscopy;
Brain;
Glucose;
Oxygen consumption
- From:
Chinese Journal of Anesthesiology
1997;0(11):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the changes in cerebral oxygen delivery/consumption and glucose metabolism during laparoscopic gynecologic surgery under propofol-fentanyl anesthesia.Methods Fifteen ASA Ⅰ or Ⅱ patients aged 20-59 yrs weighing 47-65 kg undergoing laparoscopic gynecologic surgery under propofol-fentanyl anesthesia were studied. The patients were premedicated with scopolamine 0.3 mg, midazolam 0.02 mg?kg-1 and fentanyl-droperidol mixture 0.03 ml?kg-1 Ⅳ. Anesthesia was induced with fentanyl 2 ?g?kg-1, propofol 2 mg? kg-1 and vecuronium 0.1 mg?kg-1 and maintained with TCI of propofol with target effect-site concentration set at 3-4 ?g? ml-1 and intermittent Ⅳ boluses of fentanyl and vecuronium. The patients were mechanically ventilated (VT = 7 ml? kg-1 RR = 14 bpm, I: E = 1:2). PET CO2 was maintained at 35-45 mm Hg. Radial artery was cannulated for BP monitoring and blood sampling. Left internal jugular vein was cannulated and advanced cephalad until a resistance was met. The depth of insertion was about 11-14 cm. After the pneumoperitoneum was established ( Ultra-abdominal pressure = 15 mm Hg) , the patients were placed in head-down position. Blood samples were taken from radial artery and internal jugular vein simultaneously before anesthesia ( T1 , baseline), before pneumoperitoneum (T2) and at 10, 20 and 60 min after pneumoperitoneum was established (T3-5) for blood gas analysis and determination of plasma glucose and lactic acid concentration. Arterio-jugular oxygen content difference ( Da-jv O2 ), arterio-jugular plasma lactic acid difference ( Da-jv. Lac ), cerebral oxygen consumption and cerebral glucose extraction rate (GluER) were calculated. Jugular bulb pressure (JBP) was recorded at blood sampling.Results After pneumoperitoneum was established JBP increased significantly. Jugular bulb oxygen saturation (Sjv O2 ) increased significantly. Da-jv, O2 and cerebral oxygen extraction rate ( OER) decreased significantly after pneumoperitoneum (T3-5 ) . Plasma glucose level increased along with the pneumoperitoneum, while the Da-jv Glu, Da-jv Lac remained constant. Conclusion During laparoscopic gynecologic surgery under propofotfentanyl anesthesia cerebral venous pressure is elevated and cerebral oxygen supply exceeds oxygen consumption. Blood glucose level increases during pneumoperitoneum. However brain energy metabolism is not affected during pneumoperitoneum with patient in head-down position.
