JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (37) Citing Articles via Google Scholar Google Scholar Articles by Jansen, G. F. A. Articles by Odoom, J. A. Search for Related Content PubMed PubMed Citation Articles by Jansen, G. F. A. Articles by Odoom, J. A.

---

NEUROSURGICAL ANESTHESIA

Jugular Bulb Oxygen Saturation During Propofol and Isoflurane/Nitrous Oxide Anesthesia in Patients Undergoing Brain Tumor Surgery

Department of Anesthesiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

Address correspondence and reprint requests to Gerard F. A. Jansen, MD, Department of Anesthesiology, H-1-Z, Academic Medical Centre, University of Amsterdam, P.O. Box 22600, 1100 DE Amsterdam, The Netherlands.

We investigated, in brain tumor patients, the jugular bulb venous oxygen partial pressure (PjO₂) and hemoglobin saturation (SjO₂), the arterial to jugular bulb venous oxygen content difference (AJDO₂), and middle cerebral artery blood flow velocity (Vmca) during anesthesia, and the effect of hyperventilation on these variables. Twenty patients were randomized to receive either isoflurane/nitrous oxide/fentanyl (Group 1) or propofol/fentanyl (Group 2). At normoventilation (PaCO₂ 35 ± 2 mm Hg in Group 1 and 33 ± 3 mm Hg in Group 2), SjO₂ and PjO₂ were significantly higher in Group 1 than in Group 2 (SjO₂ 60% ± 6% and 49% ± 13%, respectively; P = 0.019) (PjO₂ 32 ± 3 and 27 ± 5 mm Hg, respectively; P = 0.027). In Group 2, 5 of 10 patients had SjO₂ <50%, and 3 of these patients had SjO₂ <40% and AJDO₂ >9 mL/dL. All patients in Group 1 had SjO₂ >50%. During hyperventilation, there were no differences in SjO₂, PjO₂, or AJDO₂ between the two groups. On hyperventilation, there was no correlation between the relative decreases of Vmca and 1/AJDO₂ (r = 0.21, P = 0.41). The results indicate during propofol anesthesia, half of the brain tumor patients showed signs of cerebral hypoperfusion, but not during isoflurane/nitrous oxide anesthesia. Furthermore, during PaCO₂ manipulations, shifts in Vmca are inadequate to evaluate brain oxygen delivery in these patients.

Implications: During propofol anesthesia at normoventilation, 50% of brain tumor patients showed signs suggesting cerebral hypoperfusion, but this could not be demonstrated during isoflurane/nitrous oxide anesthesia. During PaCO₂ manipulations, consecutive measurements of the cerebral blood flow velocity may be inadequate to assess cerebral oxygenation.

This article has been cited by other articles:

				A. W. Gelb, R. A. Craen, G. S. U. Rao, K. R. M. Reddy, J. Megyesi, B. Mohanty, H. H. Dash, K. C. Choi, and M. T. V. Chan Does Hyperventilation Improve Operating Condition During Supratentorial Craniotomy? A Multicenter Randomized Crossover Trial Anesth. Analg., February 1, 2008; 106(2): 585 - 594. [Abstract] [Full Text] [PDF]

				A. Conti, D. G. Iacopino, V. Fodale, S. Micalizzi, O. Penna, and L. B. Santamaria Cerebral haemodynamic changes during propofol-remifentanil or sevoflurane anaesthesia: transcranial Doppler study under bispectral index monitoring Br. J. Anaesth., September 1, 2006; 97(3): 333 - 339. [Abstract] [Full Text] [PDF]

				M. Rasmussen, R. N. Upton, C. Grant, A. M. Martinez, G. E. Cold, and G. Ludbrook The effects of indomethacin on intracranial pressure and cerebral hemodynamics during isoflurane or propofol anesthesia in sheep with intracranial hypertension. Anesth. Analg., June 1, 2006; 102(6): 1823 - 1829. [Abstract] [Full Text] [PDF]

				J. C. Diephuis, K. G. M. Moons, A. N. Nierich, M. Bruens, D. van Dijk, and C. J. Kalkman Jugular bulb desaturation during coronary artery surgery: a comparison of off-pump and on-pump procedures Br. J. Anaesth., June 1, 2005; 94(6): 715 - 720. [Abstract] [Full Text] [PDF]

				K. Yoshitani, M. Kawaguchi, M. Iwata, N. Sasaoka, S. Inoue, N. Kurumatani, and H. Furuya Comparison of changes in jugular venous bulb oxygen saturation and cerebral oxygen saturation during variations of haemoglobin concentration under propofol and sevoflurane anaesthesia Br. J. Anaesth., March 1, 2005; 94(3): 341 - 346. [Abstract] [Full Text] [PDF]

				K. Yoshitani, M. Kawaguchi, K. Tatsumi, N. Sasaoka, N. Kurumatani, and H. Furuya Intravenous Administration of Flurbiprofen Does Not Affect Cerebral Blood Flow Velocity and Cerebral Oxygenation Under Isoflurane and Propofol Anesthesia Anesth. Analg., February 1, 2004; 98(2): 471 - 476. [Abstract] [Full Text] [PDF]

				A. J. Johnston, L. A. Steiner, D. A. Chatfield, M. R. Coleman, J. P. Coles, P. G. Al-Rawi, D. K. Menon, and A. K. Gupta Effects of propofol on cerebral oxygenation and metabolism after head injury Br. J. Anaesth., December 1, 2003; 91(6): 781 - 786. [Abstract] [Full Text] [PDF]

				T. Iwata, S. Inoue, M. Kawaguchi, M. Takahashi, T. Sakamoto, K. Kitaguchi, H. Furuya, and T. Sakaki Comparison of the effects of sevoflurane and propofol on cooling and rewarming during deliberate mild hypothermia for neurosurgery Br. J. Anaesth., January 1, 2003; 90(1): 32 - 38. [Abstract] [Full Text] [PDF]

				L. Schaffranietz, C. Rudolph, W. Heinke, H. R. Munoz, and J. E. De la Fuente Propofol, Nitrous Oxide, and Jugular Bulb Oxygen Saturation * Response Anesth. Analg., November 1, 2002; 95(5): 1459 - 1460. [Full Text] [PDF]

				A. Cenic, R. A. Craen, T.-Y. Lee, and A. W. Gelb Cerebral Blood Volume and Blood Flow Responses to Hyperventilation in Brain Tumors During Isoflurane or Propofol Anesthesia Anesth. Analg., March 1, 2002; 94(3): 661 - 666. [Abstract] [Full Text] [PDF]

				H. R. Munoz, G. E. Nunez, J. E. de la Fuente, and M. G. Campos The Effect of Nitrous Oxide on Jugular Bulb Oxygen Saturation During Remifentanil Plus Target-Controlled Infusion Propofol or Sevoflurane in Patients with Brain Tumors Anesth. Analg., February 1, 2002; 94(2): 389 - 392. [Abstract] [Full Text] [PDF]

				S. Saito, Y. Kadoi, T. Nara, M. Sudo, H. Obata, T. Morita, and F. Goto The Comparative Effects of Propofol Versus Thiopental on Middle Cerebral Artery Blood Flow Velocity During Electroconvulsive Therapy Anesth. Analg., December 1, 2000; 91(6): 1531 - 1536. [Abstract] [Full Text] [PDF]

				M. Olive, M. Noguer, G. F. A. Jansen, M. B. Kedaria, J. A. Odoom, and B. H. van Praagh Global Cerebral Hypoperfusion and PaCO2 Response Anesth. Analg., April 1, 2000; 91(1): 246 - 246. [Full Text] [PDF]

				C. De Deyne, R. De Jongh, R. Heylen, M. Struys, G. Jansen, M. Kedaria, J. Odoom, and B. van Praagh Jugular Bulb Desaturations During Propofol Anesthesia in Neurosurgical Procedures • Response Anesth. Analg., March 1, 2000; 90(3): 769 - 769. [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999