Cerebral Oxygen Saturation Measured by Near-infrared Spectroscopy and Jugular Venous Bulb Oxygen Saturation during Arthroscopic Shoulder Surgery in Beach Chair Position under Sevoflurane-Nitrous Oxide or Propofol-Remifentanil Anesthesia
Jeong H et al. – The margin of safety against impaired cerebral oxygenation is greater and ugular venous bulb oxygen saturation (SjvO2) is more preserved with sevoflurane–nitrous oxide (S/N) than with P/R anesthesia. SctO2 may not be reliable in detecting a low SjvO2 during the surgery in beach chair position (BCP).
Forty patients undergoing shoulder surgery in BCP were randomly assigned to receive sevoflurane-nitrous oxide (S/N) or propofol-remifentanil (P/R) anesthesia.
Four patients taking angiotensin II receptor antagonists were excluded post hoc.
Mean arterial pressure and heart rate, as well as SjvO2 and SctO2, were measured before (postinduction baseline in supine position) and after BCP.
Mean arterial pressure decreased by BCP in both groups.
It was, however, significantly higher in S/N (n=19) than in P/R group (n=17) at 7 to 8min after the positioning.
SjvO2 also significantly decreased after BCP in both groups, the magnitude of which was lower in S/N than in P/R group (11&plismn;10% vs. 23±9%, P=0.0006).
The incidences of SjvO2 <50% and mean arterial pressure less than 50mmHg were lower in S/N group, but SctO2and the incidence of cerebral desaturation (more than 20% decrease from baseline) did not significantly differ between the groups.
SctO2 and SjvO2 were only weakly correlated (β=0.218, r2=0.133).
Bland-Altman analysis showed a mean difference of -7.2% with 95% limit of agreement between -38.2% and 23.8%.
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