• Tadahiko Ishiyama, Masakazu Kotoda, Nobumasa Asano, Kodai Ikemoto, Noriyuki Shintani, Toru Matsuoka, and Takashi Matsukawa.
• From the Surgical Center, University of Yamanashi Hospital (TI) and Department of Anesthesiology, Faculty of Medicine, University of Yamanashi (MK, NA, KI, NS, TM), Chuo, Yamanashi, Japan.
• Eur J Anaesthesiol. 2016 Dec 1; 33 (12): 929-935.

BackgroundNear-infrared spectroscopy estimates cerebral regional tissue oxygen saturation (rSO2), which may decrease under hyperventilation. Propofol and sevoflurane act differently on cerebral blood vessels. Consequently, cerebral blood flow during hyperventilation with propofol and sevoflurane anaesthesia may differ.ObjectivesThe first aim of this study was to compare the changes in rSO2 between propofol and sevoflurane anaesthesia during hyperventilation. The second aim was to assess changes in rSO2 with ventilation changes.DesignA randomised, open-label study.SettingUniversity of Yamanashi Hospital, Yamanashi, Japan from January 2014 to September 2014.ParticipantsFifty American Society of Anesthesiologists physical status 1 or 2 adult patients who were scheduled for elective abdominal surgery were assigned randomly to receive either propofol or sevoflurane anaesthesia. Exclusion criterion was a known history of cerebral disease such as cerebral infarction, cerebral haemorrhage, transient ischaemic attack and subarachnoid haemorrhage.InterventionsAfter induction of anaesthesia but before the start of surgery, rSO2, arterial carbon dioxide partial pressure (PaCO2) and arterial oxygen saturation were measured. Measurements were repeated at 5-min intervals during 15 min of hyperventilation with a PaCO2 around 30 mmHg (4 kPa), and again after ventilation was normalised.Main Outcome MeasuresThe primary outcome was the difference of changes in rSO2 between propofol anaesthesia and sevoflurane anaesthesia during and after hyperventilation. The second outcome was change in rSO2 after the initiation of hyperventilation and after the normalisation of ventilation.ResultsChanges of rSO2 during hyperventilation were -10 ± 7% (left) and -11 ± 8% (right) in the propofol group, and -10 ± 8% (left) and -9 ± 7% (right) in the sevoflurane group. After normalisation of PaCO2, rSO2 returned to baseline values. Arterial oxygen saturation remained stable throughout the measurement period. The rSO2 values were similar in the propofol and the sevoflurane groups at each time point.ConclusionThe effects of hyperventilation on estimated rSO2 were similar with propofol and sevoflurane anaesthesia. Changes in rSO2 correlated well with ventilation changes.Trial RegistrationJapan Primary Registries Network (JPRN); UMIN-CTR ID; UMIN000010640.

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