Comparison of the effect of sevoflurane or propofol anesthesia on the regional cerebral oxygen saturation in patients undergoing carotid endarterectomy: a prospective, randomized controlled study

BACKGROUND: The monitoring of regional cerebral oxygen saturation (SrO(2)) using near-infrared spectroscopy is useful method to detect cerebral ischemia during. Sevoflurane and propofol decrease cerebral metabolic rate (CMRO(2)) in a similar manner, but the effects on the cerebral blood flow (CBF) are different. We hypothesized that the effects of sevoflurane and propofol on SrO(2) were different in patients with deficits of CBF. This study compared the effect of sevoflurane and propofol on SrO(2) of patients undergoing cerebral endarterectomy (CEA). METHOD: Patients undergoing CEA were randomly assigned to the sevoflurane or propofol group (n = 74). The experiment was preceded in 2 stages based on carotid artery clamping. The first stage was from induction of anaesthesia to immediately before clamping of the carotid artery, and the second stage was until the end of the operation after clamping of the carotid artery. Oxygen saturation (SrO(2), SpO(2)), haemodynamic variables (blood pressure, heart rate), respiratory parameters (end-tidal carbon dioxide tension, inspired oxygen tension), concentration of anesthetics, and anesthesia depth (bispectral index score) were recorded. RESULTS: During stage 1 period (before carotid artery clamping), the mean value of the relative changes in SrO(2) was higher (P = 0.033) and the maximal decrease in SrO(2) was lower in the sevoflurane group compared with the propofol group (P = 0.019) in the contralateral (normal) site. However, there is no difference in ipsilateral site (affected site). SrO(2) decreased after carotid artery clamping and increased after declamping, but the difference was not significant between two groups. Changes in mean arterial blood pressure was lower in sevoflurane group than propofol group after the carotid artery declamping (P = 0.048). CONCLUSION: Propofol-remifentanil anesthesia was comparable with sevoflurane-remifentanil anesthesia in an aspect of preserving the SrO(2) in patients undergoing carotid endarterectomy. TRIAL REGISTRATION: Clinical Trials.gov identifier: NCT02609087, retrospectively registered on November 18, 2015.