Turkish Neurosurgery
Effects of Sevoflurane and Propofol Anesthesia on Cerebral Oxygenation in Patients Undergoing Carotid Endarterectomy
Zeynep Cura1, Bahar Oc1, Oguzhan Arun1, Mehmet Oc2, Ipek Duman3, Ateş Duman1
1Selcuk University, Faculty of Medicine, Anesthesiology and Intensive Care, Konya,
2Selcuk University, Faculty of Medicine, Cardiovascular Surgery, Konya,
3Necmettin Erbakan University, Meram Faculty of Medicine, Medical Pharmacology, Konya,
DOI: 10.5137/1019-5149.JTN.33776-21.2

Aim:Information regarding the impact of the anesthesia technique on the neurological outcome of patients receiving carotid endarterectomy (CEA) is scarce. CEA requires the clamping of the ipsilateral carotid artery. Cerebral oximetry is based on near-infrared spectroscopy (NIRS) and can detect hypoperfusion during carotid artery clamping. This retrospective study compares the effects of sevoflurane and propofol anesthesia on perioperative cerebral oxygenation in patients undergoing CEA under general anesthesia by using NIRS monitoring.Material and Methods:The perioperative data of 33 patients undergoing CEA were retrospectively evaluated. The study groups were organized according to the anesthesia drugs used for maintenance: sevoflurane (n = 17) and propofol (n = 16). The regional cerebral oxygen saturation (rScO2) of the ipsilateral and contralateral hemispheres was monitored continuously using a NIRS instrument and analyzed at specific time points starting from induction to the 12th hour postoperation. The data were analyzed using the appropriate tests, and a p value of <0.05 was considered significant.Results:Compared with those of groups with non-clamped hemispheres, the rScO2 values of the sevoflurane and propofol groups decreased significantly during clamping (p < 0.05) and increased to above-preoperative values after declamping (p < 0.05). When the sevoflurane and propofol groups were compared, a significant decrease in rScO2 was noted during extubation in the sevoflurane group (p<0.05). In the propofol group, female patients had significantly lower rScO2 values compared with male patients during clamping of the carotid artery (p < 0.05). None of the observed decreases were greater than 20%, which is considered an indication for shunting.Conclusion:Our NIRS monitoring results indicate that sevoflurane or propofol anesthesia does not generally cause significant differences in cerebral oxygenation during and after cross-clamping in patients undergoing CEA. The finding of sex-related differences in cerebral oxygenation in patients receiving propofol and decreased oxygenation during extubation in patients receiving sevoflurane warrants further studies.

Corresponding author : Ipek Duman