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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.

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