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NEUROSURGICAL ANESTHESIA

The Effect of Nitrous Oxide on Jugular Bulb Oxygen Saturation During Remifentanil Plus Target-Controlled Infusion Propofol or Sevoflurane in Patients with Brain Tumors

Hernán R. Muñoz, MD, MSc^*, Gastón E. Núñez, MD, PhD^*, José E. de la Fuente, MD^*, and Manuel G. Campos, MD, PhD

Departments of *Anesthesiology and Neurosurgery, Catholic University School of Medicine, Santiago, Chile

Address correspondence to Hernán R. Muñoz, MD, MSc, Departmento de Anestesiología, Universidad Católica de Chile, Marcoleta 367, PO Box 114-D, Santiago, Chile. Address e-mail to hmunoz{at}med.puc.cl Reprints will not be available from the author.

During propofol/fentanyl anesthesia, a large percentage of patients have jugular bulb oxygen saturation (SjO₂) <50%. The incidence is less with isoflurane/N₂O. We evaluated the effect of N₂O on SjO₂ during remifentanil-based anesthesia with concurrent propofol or sevoflurane in 20 adults undergoing brain tumor surgery. Anesthesia was randomized: Group 1 (n = 10), target-controlled infusion propofol; and Group 2 (n = 10), thiopental 2–3 mg/kg followed by sevoflurane 0.9% end-tidal. Jugular bulb and arterial blood samples for gas analysis were withdrawn during the administration of oxygen 33% with nitrogen 67% and then with N₂O 67%. All samples were drawn before surgery and 20 min after the addition of the study gas and with an ETCO₂ 26–28 mm Hg and mean arterial pressure >90 mm Hg. Both groups had similar demographic and physiologic data. In the Propofol group, SjO₂ was 50% ± 10% with nitrogen and 52% ± 9% with N₂O (not significant); in the Sevoflurane group, however, N₂O 67% increased SjO₂ from 56% ± 13% to 66% ± 12% (P < 0.01). This indicates that N₂O does not reduce the incidence of low SjO₂ values during propofol anesthesia.

IMPLICATIONS: This study demonstrates that nitrous oxide can increase jugular bulb venous oxygen saturation when added to sevoflurane/remifentanil anesthesia, but not to propofol/remifentanil anesthesia, in patients with brain tumors.

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