Effects of Sevoflurane and Propofol Anesthesia on Cerebral Oxygenation in Patients Undergoing Carotid Endarterectomy

Abstract

AIM: To compare the effects of sevoflurane and propofol anesthesia on perioperative cerebral oxygenation in patients undergoing carotid endarterectomy (CEA) under general anesthesia by using near-infrared spectroscopy (NIRS) monitoring. MATERIAL and METHODS: Institutional approval was obtained, and 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 was 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.