అనస్థీషియా & క్లినికల్ రీసెర్చ్
అందరికి ప్రవేశం
ISSN: 2155-6148
ISSN: 2155-6148
Hani I Taman, Rami A Sabry and Ashraf Abdelrahman
Background: Neurological complications after pediatric open cardiac surgery represents a great challenge to all anesthetists. Cognitive domains may be affected with or without behavioral change. Cerebral air embolization and hypoperfusion are considered as fundamental causes. Transcranial Doppler can determine any air emboli entering brain circulation intra-operatively. Together with cerebral oximetry, they can detect any harmful embolic events during open cardiac surgery. New models of neuroprotective strategies were implanted to ameliorate this problem including different anesthetic medications like propofol and sevoflurane.
Methods: 120 patients who were planned for elective cardiac surgery were recruited in this study. Anesthesia was maintained with Propofol infusion at a rate of 150 μg/Kg/min or sevoflurane 1 MAC. Cerebral oximetry and transcranial Doppler sonography were used to monitor cerebral blood flow, air embolization and oxygenation with evaluation of their neurocognitive function using The Mini-Mental State Examination (MMSE).
Results: Embolic events were higher in seveoflurane group when compared to propofol group at insertion and removal of aortic cannula as well as on release of aortic cross clamp. Mean arterial pressure and mean velocity of middle cerebral blood flow were higher in sevoflurane group when compared with propofol group. Also velocity mean were lower in comparison to basal values in propofol group. MMSE score comparison between both groups were of no significant difference.
Conclusion: In comparison to sevoflurane, propofol decrease the incidence of cerebral air embolic events, mean cerebral blood flow velocity and MAP more than sevoflurane. Meanwhile, it has equivalent effect to sevoflurane regarding regional cerebral oxygen saturation and neurocognitive outcome.