Protective effects of propofol and isoflurane on cerebral oxygen metabolism and cerebral injury during cardiopulmonary bypass:A comparative study

Abstract

Abstract: AIM: To observe the protective effects of isoflurane and propofol by the changes of cerebral oxygen supply-demands balance and serum concentration of S100β and NSE protein in cardiac valve replacement during cardiopulmonary bypass (CPB).METHODS: All of 30 patients undergoing heart valve replacement were prospectively randomized divided into isoflurane group (with isoflurane adoption) and propofol group (with propofol adoption), 15 cases for each group.Jugular venous bulb blood oxygen saturation (SjvO2), Jugular arterial-venous oxygen content difference (Da-jvO2)and cerebral oxygen extraction rate (CERO2)and radical artery blood gas analysis were measured at six stages (T1-T6)of CPB which include before CPB (T1), bring down the temperature to stability stage (T2), recovery temperature to 36 ℃(T3), 30min (T4), 6 hours (T5)and 24 hours (T6)after CPB.In addition, the jugular venous bulb blood was taken at the six time points to measure the blood concentration of S100β and NSE protein.RESULTS: Sjv-O2, Da-jvO2, CERO2 and the blood concentration of S100β and NSE protein which are brain damage markers were no significant difference (P>0.05)in two groups before CPB.SjvO2 in the two groups were both increased during cooling period and then decreased during rewarming period, but the change in propofol group is less than that in the isoflurane group(P<0.01).The blood concentrations of S100β protein and NSE protein were both increased after CPB, the concentration of protein in propofol group, however, were lower than in isoflurane group (P<0.05).CONCLUSION: Two types of anesthesia can be used in valve replacement surgery under CPB.Compared with isoflurane, propofol anesthesia is more conducive to improvement cerebral oxygen metabolism and protection of brain damage in cardiac valve replacement surgery under CPB.

Key words: isoflurane, propofol, cardiopulmonary bypass, cerebral oxygen metabolism, cerebral injury

CLC Number:

R614

GUO Jian-rong, JIA Dong-lin, REN Li-yuan, DU Jian-man, CHEN Xiao-fei, HU Li-hong. Protective effects of propofol and isoflurane on cerebral oxygen metabolism and cerebral injury during cardiopulmonary bypass:A comparative study[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2009, 14(7): 812-817.

References

[1] Wimmer GG,Matheis G, Breden M, et al.Neuropsychological changes after cardiopulmonary bypass for coronary artery bpass grafting [J].Thorac Cardiovasc Surg, 1998, 46 (4):207-212.
[2] Blumenthal JA, Mahann EP, Madden DJ, et al.Methodological issues in the assessment of neuropsycologic function after cardiac surgery [J].Ann Thorac Surg, 1995, 59 (5):1345-1350.
[3] Gao F, Harris DN, Sapsed Byrne S, et al.Neurone-specific enolase and Sangtec 100 assays during cardiac surgery: Part Ⅰ:the effects of heparin, protamine and propofol [J]. Perfusion, 1997, 12(3):163-165.
[4] Martens P, Raabe A, Johnsson P.Serum S-100 and neuronspecific enolase for prediction of regaining consciousness after global cerebral ischemia [J].Stroke, 1998, 29(11): 2363-2366.
[5] Blomquist S, Johnsson P, Luhrs C, et al.The appearance of S-100 protein in serum during and immediately after car-diopulmonary bypass surgery:a possible marker for cerebral injury [J].J Cardiothorac Vasc Anesth, 1997, 11(6): 699-703.
[6] Iwata T, Inoue S, Kawaguchi M, et al.Comparison of the effects of sevoflurane and propofol on cooling and rewarming during deliberate mild hypothermia for neurosurgery [J].Br J Anaesth, 2003, 90(1):32-38.
[7] Schell RM, Cole DJ.Cerebral monitoring:jugular venous oximetry [J].Anesth Analg, 2000, 90:559-566.
[8] Newman MF,Murkin TM, Roach G, et al.Cerebral physiologic effects of burst suppression doses of propofol during nonpulsatile cardiopulmonary bypass [J].Anesth Analg, 1999, 81(3):542-547.
[9] 王祥瑞, 杭燕南.氧供需平衡监测及其临床意义 [M] 杭燕南, 庄心良, 蒋豪, 等, 主编.当代麻醉学. 上海:上海科学技术出版社, 2002:1059-1074.
[10] 徐康清, 张劲军, 黄文起, 等.体外循环对患者肺内致炎和抗炎物质的影响 [J].中国实用医药, 2008, 3 (30):35-36.
[11] Nakajima T, Kuor M, Hayashi Y.Clinical evaluation of cerebral balance during cardiopulmonary bypass, on line continuous monitoring of jugular venous oxyhaemoglobin saturation [J].Anesth Analg, 1992, 74(5):630-635.
[12] Yoshitani K, Kawaguchi M, Sugiyama N, et al.The association of high jugular bulb venous oxygen saturation with cognitive decline after hypothemic cardiopulmonary bypass [J].Anesth Analg, 2001, 92(6):1370-1376.
[13] Grouhwell ND, Frasco P, Blumenthal JA, et al.Jugular bulb saturation and cognitive dysfunction after cardiopulmonary bypass [J].Ann Thorac Surg, 1994, 58(6):1702-1708.
[14] Farsak B, Gunaydin S, Yorgancioglu C, et al.Elevated levels of S100 beta correlate with neurocognitive outcome after cardiac surgery [J].J Cardiovasc Surg, 2003, 44:31-35 [15] Ali MS, Hamer M, Vaughan R.Serum S100 protein as a marker of cerebral damage during cardiac surgery [J].Br J Anaesth, 2000, 85(2):287-298.
[16] Jonsson H, Johnsson P, Hoglund P, et al.Elimination of S100(and renal function after cardiac surgery [J].J Cardiothorac Vasc Anesth, 2000, 14(6):698-701.
[17] Oh SH, Lee JG, Na SJ, et al.Prediction of early clinical severity and extent of neuronal damage in anterior-circulation infarction using the initial serum neuron-specific enolase level [J].Arch Neurol, 2003, 60(1):37-41.
[18] Johnsson P, Blomquist S, Luhrs C, et al.Neuron-specific enolase increases in plasma during and immediately after extracorporeal circulation [J].Ann Thorac Surg, 2000, 69 (3):750-754.
[19] Oshima T, Karasawa F, Satoh T.Effects of propofol on cerebral blood flow and the metabolic rate of oxygen in humans [J].Acta Anaesthesiol Scand, 2002, 46(7):831-835.
[20] Yoshitni K, Kawaguchi M, Iwata M, et al.Comparison of changes in jugular venous bulb oxygen saturation and cerebral oxygen saturation during variations of haemoglobin concentration under propofol and sevoflurane anaesthesia [J].Br J Anaesth, 2005, 94(3):341-346.
[21] Takizawa E, Hiraoka H, Takizawa D, et al.Changes in the effects of propofol in response to altered plasma protein binding during normothermic cardiopulmonary bypass [J]. Br J Anaesth, 2006, 96(2):179-185.