Objective: To evaluate the effects of various degrees of hyperventilation on balance of cerebral oxygensupply and consumption during intravenous general anesthesia with jugular venous oxygen saturation monitoringMetbo...Objective: To evaluate the effects of various degrees of hyperventilation on balance of cerebral oxygensupply and consumption during intravenous general anesthesia with jugular venous oxygen saturation monitoringMetbods: Sixty-six patients with supratentorial tumor undergoing intravenous general anesthesia for brain surgerywere randomly divided into three groups. In group Ⅰ, Ⅱ and Ⅲ, end-tidal pressure of Co2(PETCO2) were maintained at 3. 5, 4. 0 and 4. 5 kPa respectively. Radial arterial blood samples and jugular bulb blood samples weretaken synchronously at 60 min after hyperventilation to measure jugular venous oxygen saturation (SjvO2), cerebral extraction of oxygen (CEO2) and cerebral arteriovenous oxygen content difference (AVDO2) were calculatedResults: In group Ⅰ after hyperventilation, SjvO, and jugular venous oxygen content (CjvO2) were decreasedmarkedly while CEO2 was increased significantly, which was different significantly compared with the baseline andcorresponding value in group Ⅱ and Ⅲ (P<0. 05). After hyperventilation in group, and, SjvO2 CjvO2, CEO2and AVDO, remained unchanged. Conclusion: This study shows that sustained excessive hyperventilation (PETCO23.5 kPa) may account for the less favorable cerebral oxygen supply and consumption balance and maintained PETCO, at 4. 0~4. 5 kPa was optimal hyperventilation for brain surgery anesthesia.展开更多
Objective: To assess the effects of various anesthetic techniques and PaCO2 levels on cerebral oxygen supply/consumption balance during craniotomy for removal of tumors, and to explore an anesthetic technique for neur...Objective: To assess the effects of various anesthetic techniques and PaCO2 levels on cerebral oxygen supply/consumption balance during craniotomy for removal of tumors, and to explore an anesthetic technique for neurosur-gery and an appropriate degree of PaCO2 during neuroanesthesia. Methods: One hundred and fourteen patients with supratentorial tumors for elective craniotomy, ASA grade I - II , were randomly allocated to six groups. Patients were anesthetized with continuous intravenous infusion of 2% procaine 1. 0 mg · kg-1 · min-1 in Group I , inhalation of 1. 0% - 1. 5% isoflurane in Group II , and infusion of 2% procaine 0. 5 mg·kg · min-1 combined with inhalation of 0.5% -0.7% isoflurane in Group III during the period of study. The end-tidal pressure of CO2(PET CO2 ) was maintained at 4.0 kPa in these 3 groups. In Group IV, V and VI, the anesthetic technique was the same as that in Group I but the PETCO2 was adjusted to 3. 5, 4. 0 and 4. 5 kPa respectively for 60 min during which the study was performed. The radial arterial and retrograde jugular venous blood samples were obtained at the onset and the end of this study for determining jugular venous bulb oxygen saturation ( SjvO2 ) , arteriovenous oxygen content difference (AVDO2) and cerebral extraction of oxygen (CEO2). Results: In Group I and I SjvO2, AVDO2 and CEO2 remained stable. Although SjvO2 kept constant, AVDO2 and CEO2 decreased significantly (P <0. 05) in Group II. Moreover, AVDO2 and CEO2 in Group II were significantly lower than those of Group III (P<0. 05). In Group IV, 60 min after hyperventilation, SjvO2 and jugular venous oxygen content ( CjvO2 ) decreased markedly (P < 0. 01 ) while CEO2 increased significantly ( P <0.01) . In addition, SjvO2, CjvO2 and CEO2 in Group IV were significantly different from the corresponding parameters in Group V and Group VI (P <0. 05) . In view of sustained excessive hyperventilation, SjvO2 was less than 50% in 37.5% patients of Group IV. Conclusion: Anesthesia with intravenous infusion of procaine combined with isoflurane inhalation proved to be more suitable for neurosurgery than procaine intravenous anesthesia or isoflurane inhalation anesthesia alone. PaCO2 at 4.0 -4. 5 kPa in patients undergoing craniocerebral surgery during neuroanesthesia would be beneficial in both decreasing ICP and maintaining cerebral oxygen supply/consumption balance.展开更多
文摘Objective: To evaluate the effects of various degrees of hyperventilation on balance of cerebral oxygensupply and consumption during intravenous general anesthesia with jugular venous oxygen saturation monitoringMetbods: Sixty-six patients with supratentorial tumor undergoing intravenous general anesthesia for brain surgerywere randomly divided into three groups. In group Ⅰ, Ⅱ and Ⅲ, end-tidal pressure of Co2(PETCO2) were maintained at 3. 5, 4. 0 and 4. 5 kPa respectively. Radial arterial blood samples and jugular bulb blood samples weretaken synchronously at 60 min after hyperventilation to measure jugular venous oxygen saturation (SjvO2), cerebral extraction of oxygen (CEO2) and cerebral arteriovenous oxygen content difference (AVDO2) were calculatedResults: In group Ⅰ after hyperventilation, SjvO, and jugular venous oxygen content (CjvO2) were decreasedmarkedly while CEO2 was increased significantly, which was different significantly compared with the baseline andcorresponding value in group Ⅱ and Ⅲ (P<0. 05). After hyperventilation in group, and, SjvO2 CjvO2, CEO2and AVDO, remained unchanged. Conclusion: This study shows that sustained excessive hyperventilation (PETCO23.5 kPa) may account for the less favorable cerebral oxygen supply and consumption balance and maintained PETCO, at 4. 0~4. 5 kPa was optimal hyperventilation for brain surgery anesthesia.
基金Supported by the"Tenth five-year-plan"Medical Science Foundation of PLA(NO.01M118 to Dr.CHEN).
文摘Objective: To assess the effects of various anesthetic techniques and PaCO2 levels on cerebral oxygen supply/consumption balance during craniotomy for removal of tumors, and to explore an anesthetic technique for neurosur-gery and an appropriate degree of PaCO2 during neuroanesthesia. Methods: One hundred and fourteen patients with supratentorial tumors for elective craniotomy, ASA grade I - II , were randomly allocated to six groups. Patients were anesthetized with continuous intravenous infusion of 2% procaine 1. 0 mg · kg-1 · min-1 in Group I , inhalation of 1. 0% - 1. 5% isoflurane in Group II , and infusion of 2% procaine 0. 5 mg·kg · min-1 combined with inhalation of 0.5% -0.7% isoflurane in Group III during the period of study. The end-tidal pressure of CO2(PET CO2 ) was maintained at 4.0 kPa in these 3 groups. In Group IV, V and VI, the anesthetic technique was the same as that in Group I but the PETCO2 was adjusted to 3. 5, 4. 0 and 4. 5 kPa respectively for 60 min during which the study was performed. The radial arterial and retrograde jugular venous blood samples were obtained at the onset and the end of this study for determining jugular venous bulb oxygen saturation ( SjvO2 ) , arteriovenous oxygen content difference (AVDO2) and cerebral extraction of oxygen (CEO2). Results: In Group I and I SjvO2, AVDO2 and CEO2 remained stable. Although SjvO2 kept constant, AVDO2 and CEO2 decreased significantly (P <0. 05) in Group II. Moreover, AVDO2 and CEO2 in Group II were significantly lower than those of Group III (P<0. 05). In Group IV, 60 min after hyperventilation, SjvO2 and jugular venous oxygen content ( CjvO2 ) decreased markedly (P < 0. 01 ) while CEO2 increased significantly ( P <0.01) . In addition, SjvO2, CjvO2 and CEO2 in Group IV were significantly different from the corresponding parameters in Group V and Group VI (P <0. 05) . In view of sustained excessive hyperventilation, SjvO2 was less than 50% in 37.5% patients of Group IV. Conclusion: Anesthesia with intravenous infusion of procaine combined with isoflurane inhalation proved to be more suitable for neurosurgery than procaine intravenous anesthesia or isoflurane inhalation anesthesia alone. PaCO2 at 4.0 -4. 5 kPa in patients undergoing craniocerebral surgery during neuroanesthesia would be beneficial in both decreasing ICP and maintaining cerebral oxygen supply/consumption balance.
