Cerebral Oxygenation and Metabolism in Patients Undergoing Clipping of Cerebral Aneurysm: A Comparative Study between Propofol-based total intravenous anesthesia and Sevoflurane-based inhalational anesthesia.

Figures & data

Figure 1. Consort flow diagram

Figure Legend: Consort flow diagram, patients assessed for eligibility to participate in this work were 56, four patients didn’t accept to be a part of the study, and two other patients showed rapid deterioration the night before surgery (increased intracranial pressure) which necessitated emergency external ventricular drainage (EVD). The remaining 50 patients were randomly divided into two equal groups; group P (Total Intravenous group, n;25) and group S (Inhalation group, n;25). The outcome measures were obtained from the 50 patients and data were analyzed.

Table 1. Patients characteristics

Variable		Group (P) N;25	Group (S) N;25	P-value
Age (years)		54.00 ± 4.94	51.92 ± 5.09	0.149
ASA І ІІ		13(52.0%) 12(48%)	16(64%) 9(36%)	0.390
BMI		30.92 ± 2.64	30.80 ± 3.06	0.883
Gender	Male	16 (64%)	17(68.0%)	0.765
	Female	9 (36%)	8 (32.0%)
GCS	14	0(0%)	2(8%)	0.149
	15	25(100%)	23(92%)
Fischer grade	1	4(16%)	5(20%)	0.5
	II	9(36%)	11(44%)
	III	12(48%)	9(36%)
Preoperative Hb (gm/dl)		12.93 ± 1.35	13.16 ± 1.63	0.599

-This table shows the study patient demographic data, fisher grade of subarachnoid bleed, basal hemoglobin level, and GCS: Glasgow coma scale level of consciousness.

-Data expressed in Mean ± SD or number and %.

-Group P; total intravenous group, Group S; Sevoflurane group, N; number, HB; hemoglobin, gm/dl; gram per deciliter, BMI: Body Mass Index. ASA: American Society of Anesthesiologists. GCS: Glasgow coma scale.

Table 2. Peripheral oxygen saturation (SpO2), mean arterial blood pressure, end tidal carbon dioxide

	Basal	A. Intu.	30 m	60 m	90 m	120 m	150 m	180 m	210 m	After scalp closure
SPO2 G.P G.S P. value	98.22± 0.92	98.86± 0.69	98.76± 0.66	98.85± 0.73	98.52± 1.26	98.00± 0.81	98.36± 0.75	98.16± 1.02	98.16± 0.80	98.12± 0.66
	98.34± 0.89	99.04± 0.54	98.51± 0.86	98.95± 0.60	98.93± 0.63	98.38± 1.08	98.16± 0.80	98.32± 0.69	98.20± 0.81	97.96± 0.73
	0.666	0.314	0.252	0.587	0.158	0.163	0.368	0.522	0.862	0.424
MAP G.P G.S P. value	103.05± 5.22	93.15± 4.48	82.31± 3.34	74.09± 4.09	70.15± 3.40	66.32± 6.21	64.93± 3.43*	65.60± 5.85*	70.65 ±3.37*	79.80± 7.21*
	103.08± 3.48	96.33± 4.22	86.04± 4.17	81.96± 4.18	78.64± 4.29	77.56± 4.56	76.00± 4.69	71.96± 3.89	74.56± 5.0	84.76± 5.13
	0.983	0.013*	<0.001*	<0.001*	<0.001*	<0.001*	<0.001*	<0.001*	0.002*	0.008*
PEtCO2 G.P G.S P. value	-	35.92± 1.86	34.36± 0.51	33.64± 0.50	32.24± 0.74	32.36± 0.50	32.16± 1.06	32.04± 1.01	33.80± 0.95	36.76± 1.05
	-	37.00± 0.00	35.00± 0.00	34.24± 0.83	32.88± 0.60	34.88± 1.50	33.12± 1.61	33.20± 1.35	34.44± 1.19	37.21± 0.99
	-	0.006*	0.038*	0.010*	0.003*	<0.001*	0.016*	<0.001*	0.042*	0.129

-Table Legend: This table shows; Peripheral oxygen saturation (SpO2), mean arterial blood pressure (MAP) in mm/hg; end tidal carbon dioxide (PETCO2) in mmHg. Data expressed as Mean ±SD. Group P; total intravenous group. Group S; Sevoflurane inhalational group. N; number, A. Intu.; At intubation, m; minute. *: Statistically significant p ≤ 0.05, when compared with the other group.

Figure 2. Heart rate

Figure Legend: This figure shows Heart rate (HR) with significant decrease in (P) group compared to (S) group in the two studied groups. Group P = Propofol group. Group S = Sevoflurane group.

Figure 3. Central venous pressure (CVP)

Figure Legend: This figure shows central venous pressure (CVP) with no significant difference in between both groups. Group P = Propofol group. Group S = Sevoflurane group

Table 3. Jugular Oxygen saturation and the arterio-jugular oxygen content difference

Variables		Group (P) N;25	Group (S) N;25	p-value
SjO2	After Cannulation	68.28 ± 8.67*	72.19 ± 2.95	0.041
	1 h	67.96 ± 9.67*	72.27 ± 4.54	0.049
	2 h	66.40 ± 8.53*	71.20 ± 7.29	0.038
	3 h	65.63 ± 8.75*	71.26 ± 3.50	0.005
	After scalp Closure	65.02 ± 8.82*	71.40 ± 3.69	0.004
CaO2-jO2	After cannulation	5.92 ± 1.71*	4.96 ± 0.82	0.015
	After 1 h	5.98 ± 1.78*	5.07 ± 1.11	0.036
	After 2 h	6.21 ± 1.53*	5.10 ± 1.41	0.011
	After 3 h	6.31 ± 1.55*	5.16 ± 0.88	0.003
	After scalp closure	6.41 ± 1.62* (p = 0.043)†	5.08 ± 0.75	0.001

- This Table Shows: Jugular oxygen saturation (SjO2) (%) and the Arterio-Jugular oxygen content difference (CaO2-jO2) in the two studied groups, -Data expressed as Mean ± SD.

-Group P; total intravenous group, Group S; inhalational group, N; number.

-*: Statistically significant p ≤ 0.05, when compared with the other group.

-†: Statistically significant p ≤ 0.05, when compared with the first result (after Cannulation) in the same group.

Table 4. Cerebral blood flow equivalent (CBFe) & Serum Lactate (mg/DL)

CBFe & Serum Lactate (mg/DL)		Group (P) N;25	Group (S) N;25	p-value
CBFe	After Cannulation	0.18 ± 0.04*	0.21 ± 0.03	0.039
	After 1 h	0.18 ± 0.06	0.21 ± 0.05	0.167
	After 2 h	0.17 ± .0.04*	0.20 ± 0.04	0.008
	After 3 h	0.16 ± 0.04*	0.19 ± 0.03	0.009
	After scalp Closure	0.16 ± 0.05*	0.20 ± 0.03	0.003
Serum Lactate	After Cannulation	14.03 ± .1.61	16.94 ± 1.42	0.061
	After 1 h	15.45 ± 1.57* † (p = 0.001)	20.42 ± 9.48 † (p = 0.001)	0.013
	After 2 h	15.16 ± 2.08* † (p = 0.015)	19.40 ± 8.84 † (p = 0.001)	0.024
	After 3 h	11.30 ± 1.84*	17.68 ± 10.76	0.005
	After scalp Closure	13.60 ± 1.84*	19.08 ± 10.76 † (p = 0.001)	0.016

- This table shows; Cerebral blood flow equivalent (CBFe) & Serum Lactate (mg/DL).

-Data expressed as Mean ± SD. CBFe; Cerebral blood flow equivalent (flow/metabolism Index) -Group P; total intravenous group, Group S; inhalational group, N; number. Mg/dl; milligram per deciliter. *: Statistically significant p ≤ 0.05, when compared with the other group, †: Statistically significant p ≤ 0.05, when compared with the first result (after Cannulation) in the same group.

Table 5. Cerebral extraction ratio of oxygen (CEO2) & Estimated cerebral metabolic rate for oxygen (eCMRO2) [ml/100 g/min]

Variables		Group (P)n = 25	Group (S) n = 25	p-value
CEO2	After Cannulation	31.45 ± 8.60*	26.51 ± 2.85	0.011
	After 1 h	31.64 ± 9.84*	26.62 ± 4.73	0.028
	After 2 h	33.21 ± 8.71*	27.40 ± 7.55	0.015
	After 3 h	33.79 ± 8.92*	27.34 ± 3.87	0.002
	After scalp closure	33.97 ± 8.79*	27.36 ± 3.52	0.001
eCMRO2	After Cannulation	2.01 ± 0.63*	1.68 ± 0.28	0.021
	After 1 h	2.05 ± 0.60*	1.76 ± 0.32 (p = 0.014)†	0.038
	After 2 h	2.07 ± 0.31*	1.71 ± 0.41	0.001
	After 3 h	2.06 ± 0.32*	1.74 ± 0.2	0.001
	After scalp closure	2.34 ± 0.66* (p = 0.002)†	1.95 ± 0.31 (p = 0.001)†	0.013

Table legend: This table shows; Cerebral extraction ratio of oxygen (CEO2) and Estimated cerebral metabolic rate for oxygen (eCMRO2) [ml/100 g/min] in in both of the study groups.

Data expressed as Mean ±SD. Group P = Propofol group, Group S = Sevoflurane group, n = number. *: Statistically significant p ≤ 0.05, when compared with the other group.

†: Statistically significant p ≤ 0.05, when compared with the first result (after cannulation) in the same group.

Table 6. Surgical information and ICU stay time

Variable		Group (P) N;25	Group (S) N;25	p-value
Duration of surgery (min)		155.20 ± 30.56	164.40 ± 28.73	0.278
Time of recovery (min)		13.80 ± 3.89	13.40 ± 3.13	0.691
Blood loss (ml)		950.00 ± 637.05	820.95 ± 244.94	0.346
Blood transfusion (ml)		350(0–1350)	350(0–700)	0.456
Intraoperative complications: Hypertension Arrhythmia		2(2/25) 1(1/25)	3(3/25) 2(2/25)	1.00 1.00
Urine output (UOP) (ml)		1972.00 ± 767.31	1620.00 ± 717.05	0.100
Total intraoperative fentanyl dose µg		140.00 ± 43.30	150.00 ± 47.87	0.442
Surgeon satisfaction		3 (1–3)	2 (1–3)	0.149
ICU stay time (hours)		21.76 ± 2.36	22.72 ± 6.89	0.513
Ramsey sedation scale	After extubation	5(3–6)	5(2–6)	0.579
	After 5 min	4 (2–6)	3 (2 − 6)	0.157
	After 10 min	4(2–5)	3(2–6)	0.148
	After 15 min	3(2–5)	3(2–6)	0.156
	After 20 min	3(2–4)	3(2–5)	0.660
	After 25 min	2(2–4)	2(2–5)	0.710
	Before ICU transport	2(2 − 3)	2 (2–4)	0.642

- This table shows no significant difference in between groups as regard variables surgical information and ICU stay time.

-Data expressed as Mean ± SD and surgeon satisfaction as median (min-max).

-Group P; total intravenous group. Group S; inhalational group, n; number, ICU; intensive car unite, mg; milligram, min; minute, ml; milliliter, mg; milligram, µg = microgram.

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