Prospective Randomized Trial Between Propofol Intravenous and Sevoflurane Inhaled Anesthesia on Cerebral Oximetry

Abstract

Obesity and pneumoperitoneum in the reverse-Trendelenburg position during laparoscopic sleeve gastrectomy (LSG) are reported to negatively affect cerebral oxygenation. Anesthetic agents can have variable effects on the regional cerebral tissue oxygen saturation (rSO2) measured with near-infrared spectroscopy. Our study investigated the potential impact of sevoflurane versus propofol-based anesthesia on rSO2 in LSG cases. Sixty American Society of Anesthesiologists (ASA) II-III patients, 18-65 years of age, with a body mass index of ≥35 kg/m2, undergoing LSG were randomized to two groups: sevoflurane/remifentanil (inhalation) and propofol/remifentanil (total intravenous anesthesia [TIVA]) groups for anesthesia maintenance. The rSO2 values were recorded preoperatively, 1 min after anesthesia induction, and every 5 min during surgery. Arterial blood gases (ABG) were measured in the fifth minute postinduction (t1), 30th minute postinsufflation (t2), and postextubation (t3), and correlation with rSO2 was examined. No significant difference was found between the groups in terms of rSO2 values, and cerebral desaturation was not observed in either group. ABG values were similar in both groups with moderate positive correlation between rSO2 and hemoglobin (t1, t2, t3: r = 0.365; 0.005; 0.454: p < 0.001; p = 0.494; p < 0.001, respectively). Cerebral oxygenation was preserved during both anesthetic regimens, and moderate positive correlation was found between rSO2 and hemoglobin levels. © 2020, Mary Ann Liebert, Inc., publishers.