The effect of continuous propofol versus dexmedetomidine infusion on regional cerebral tissue oxygen saturation during cardiopulmonary bypass

Metry, Ayman A.; Hussain, Noha S.; Nakhla, George M.; Ragaei, Milad Z.; Wahba, Ramy M.

doi:10.2478/rjaic-2019-0003

Abstract

Background: Cerebral oxygen desaturation can arise during various durations of cardiopulmonary bypass (CBP), thus continuous monitoring is necessary. This desaturation may account for distinct neuropsychological deficits. Near-infrared spectrophotometry (NIRS) is a non-invasive method that offers many advantages for monitoring cerebral oxygenation.

Objectives: The aim of this study was to compare the outcome of propofol and dexmedetomidine on cerebral regional oxygen saturation (rScO₂) during CPB and on postoperative cognitive dysfunction.

Patients and Methods: 50 patients anticipated for open heart surgeries were encompassed in the study. Patients were divided into 2 groups, group P (receiving propofol) and group D (receiving dexmedetomidine) during CPB. Both groups were studied for variations in right and left rScO₂ as well as postoperative cognitive dysfunction using the Mini Mental State Examination Score (MMSE) test.

Results: The results showed no significant difference in both groups of the study, with an increase in rScO₂ on the right and left side in T1 compared to T0 and maximum increase in T3-4-5, then a decrease in T6-7. With regard to the cognitive dysfunction there was a decrease in the values at 1 h in both groups without significant difference; after 1 week MMSE values returned to baseline values.

Conclusion: Propofol and dexmedetomidine infusion used during CPB preserve the rScO₂ and do not affect the neurological outcome.

References

1. Shroyer AL, Coombs LP, Peterson ED, Eiken MC, DeLong ER, Chen A, et al. The Society of Thoracic Surgeons: 30-day operative mortality and morbidity risk models. Ann Thorac Surg 2003; 75: 1856-1864. doi: 10.1016/S0003-4975(03)00179-610.1016/S0003-4975(03)00179-6
Open DOI Search in Google Scholar Back to article
2. Uehara T, Tabuchi M, Kozawa S, Mori E. MR angiographic evaluation of carotid and intracranial arteries in Japanese patients scheduled for coronary artery bypass grafting. Cerebrovasc Dis 2001; 11: 341-345. doi: 10.1159/00004766410.1159/00004766411385215
Open DOI Search in Google Scholar Back to article
3. Edmonds HL Jr, Ganzel BL, Austin EH 3rd. Cerebral oximetry for cardiac and vascular surgery. Semin Cardiothorac Vasc Anesth 2004; 8: 147-166. doi: 10.1177/10892532040080020810.1177/108925320400800208
Search in Google Scholar Back to article
4. Murkin JM, Arango M. Near-infrared spectroscopy as an index of brain and tissue oxygenation. Br J Anaesth 2009; 103 Suppl 1: i3-i13. doi: 10.1093/bja/aep29910.1093/bja/aep299
Open DOI Search in Google Scholar Back to article
5. Murkin JM, Adams SJ, Novick RJ, Quantz M, Bainbridge D, Iglesias I, et al. Monitoring brain oxygen saturation during coronary bypass surgery: a randomized, prospective study. Anesth Analg 2007; 104: 51-58. doi: 10.1213/01.ane.0000246814.29362.f410.1213/01.ane.0000246814.29362.f417179242
Open DOI Search in Google Scholar Back to article
6. Güçlü ÇY, Ünver S, Aydinli B, Kazanci D, Dilber E, Özgök A. The effect of sevoflurane vs. TIVA on cerebral oxygen saturation during cardiopulmonary bypass – randomized trial. Adv Clin Exp Med 2014; 23: 919-924. doi: 10.17219/acem/3733910.17219/acem/3733925618118
Open DOI Search in Google Scholar Back to article
7. Smith I, White PF, Nathanson M, Gouldson R. Propofol. An update on its clinical use. Anesthesiology 1994; 81: 1005-10437943815
Search in Google Scholar Back to article
8. Virtanen R, Savola JM, Saano V, Nyman L. Characterization of the selectivity, specificity and potency of medetomidine as an α₂-adrenoceptor agonist. Eur J Pharmacol 1988; 150: 9-14. doi: 10.1016/0014-2999(88)90744-310.1016/0014-2999(88)90744-3
Open DOI Search in Google Scholar Back to article
9. Lakhlani PP, MacMillan LB, Guo TZ, McCool BA, Lovinger DM, Maze M, et al. Substitution of a mutant α_2a-adrenergic receptor via “hit and run” gene targeting reveals the role of this subtype in sedative, analgesic, and anesthetic-sparing responses in vivo. Proc Natl Acad Sci USA 1997: 94: 9950-9955. doi: 10.1073/pnas.94.18.995010.1073/pnas.94.18.9950233069275232
Open DOI Search in Google Scholar Back to article
10. Chrysostomou C, Schmitt CG. Dexmedetomidine: sedation, analgesia and beyond. Expert Opin Drug Metab Toxicol 2008; 4: 619-627. doi: 10.1517/17425255.4.5.61910.1517/17425255.4.5.61918484919
Search in Google Scholar Back to article
11. Goldman S, Sutter F, Ferdinand F, Trace C. Optimizing intra-operative cerebral oxygen delivery using noninvasive cerebral oximetry decreases the incidence of stroke for cardiac surgical patients. Heart Surg Forum 2004; 7: E376-381. doi: 10.1532/HSF98.2004106210.1532/HSF98.2004106215799908
Open DOI Search in Google Scholar Back to article
12. Yao FS, Tseng CC, Ho CY, Levin SK, Illner P. Cerbral oxygen desaturation is associated with early postoperative neuropsychological dysfunction in patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth 2004; 18: 552-558. doi: 10.1053/j.jvca.2004.07.00710.1053/j.jvca.2004.07.00715578464
Open DOI Search in Google Scholar Back to article
13. Usher AG, Kearney RA, Tsui BC. Propofol total intravenous anesthesia for MRI in children. Paediatr Anaesth 2005; 15: 23-28. doi: 10.1111/j.1460-9592.2004.01390.x10.1111/j.1460-9592.2004.01390.x15649159
Open DOI Search in Google Scholar Back to article
14. Cetin M, Birbicer H, Hallioglu O, Orekeci G. Comparative study between the effects of dexmedetomidine and propofol on cerebral oxygenation during sedation at pediatric cardiac catheterization. Ann Card Anaesth 2016; 19: 20-24. doi: 10.4103/0971-9784.17301510.4103/0971-9784.173015490038426750669
Open DOI Search in Google Scholar Back to article
15. Teng Y, Ding H, Gong Q, Jia Z, Huang L. Monitoring cerebral oxygen saturation during cardiopulmonary bypass using near-infrared spectroscopy: the relationships with body temperature and perfusion rate. J Biomed Opt 2006; 11: 024016. doi: 10.1117/1.218742210.1117/1.218742216674206
Open DOI Search in Google Scholar Back to article
16. Michenfender JD. Anesthesia and the Brain: clinical, functional, metabolic, and vascular correlates. New York: Churchill Livingstone; 1988. p. 21-29
Search in Google Scholar Back to article
17. LeBlanc JG, Blackstock D, Macnab AJ, Gagnon F, Gagnon R, Russell J, et al. Effects of propofol on cerebral oxygenation during cardiopulmonary bypass in children. Can J Anaesth 2000; 47: 1082-1089. doi: 10.1007/BF0302795910.1007/BF0302795911097537
Open DOI Search in Google Scholar Back to article
18. Drummond JC, Sturaitis MK. Brain tissue oxygenation during dexmedetomidine administration in surgical patients with neurovascular injuries. J Neurosurg Anesthesiol 2010; 22: 336-341. doi: 10.1097/ANA.0b013e3181e4b7e310.1097/ANA.0b013e3181e4b7e320622684
Open DOI Search in Google Scholar Back to article
19. Everett LL, van Rooyen IF, Warner MH, Shurtleff HA, Saneto RP, Ojemann JG. Use of dexmedetomidine in awake craniotomy in adolescents: report of two cases. Paediatr Anaesth 2006; 16: 338-342. doi: 10.1111/j.1460-9592.2005.01697.x10.1111/j.1460-9592.2005.01697.x16490103
Open DOI Search in Google Scholar Back to article
20. Padmanabhan P, Berkenbosch JW, Lorenz D, Pierce MC. Evaluation of cerebral oxygenation during procedural sedation in children using near infrared spectroscopy. Ann Emerg Med 2009; 54: 205-213. doi: 10.1016/j.annemergmed.2009.02.00910.1016/j.annemergmed.2009.02.00919285362
Open DOI Search in Google Scholar Back to article
21. Casati A, Aldegheri G, Vinciguerra E, Marsan A, Fraschini G, Torri G. Randomized comparison between sevoflurane anaesthesia and unilateral spinal anaesthesia in elderly patients undergoing orthopaedic surgery. Eur J Anaesthesiol 2003; 20: 640-646. doi: 10.1017/S026502150300103010.1017/S026502150300103012932066
Open DOI Search in Google Scholar Back to article
22. te Winkel-Witlox ACM, Post MW, Visser-Melly JMA, Lindeman E. Efficient screening of cognitive dysfunction in stroke patients: Comparison between the CAMCOG and the R-CAMCOG, Mini Mental State Examination and Functional Independence Measure-cognition score. Disabil Rehabil 2008; 30: 1386-1391. doi: 10.1080/0963828070162300010.1080/0963828070162300019230177
Open DOI Search in Google Scholar Back to article
23. Maghawry KM, El-Agamy A, Tahir WI, Zein AF. Cerebral oxygen saturation monitoring during hypotensive anesthesia in shoulder arthroscopy: A comparative study between dexmedetomidine and esmolol. Egypt J Anaesth 2015; 31: 43-52. doi: 10.1016/j.egja.2014.09.00310.1016/j.egja.2014.09.003
Open DOI Search in Google Scholar Back to article
24. Townes BD, Dikmen SS, Bledsoe SW, Hornbein TF, Martin DC, Janesheski JA. Neuropsychological changes in a young, healthy population after controlled hypotensive anesthesia. Anesth Analg 1986; 65: 955-95910.1213/00000539-198609000-00008
Search in Google Scholar Back to article

The effect of continuous propofol versus dexmedetomidine infusion on regional cerebral tissue oxygen saturation during cardiopulmonary bypass

Abstract

Paradigm

My account