Comparison On Cerebral Protection Under Different Depth Anesthesia In Intracranial Aneurysm Clipping

Objective:To detect the changes of S100β protein and the cerebral oxygen metabolism level, explore the relationship between different depth of anesthesia with cerebral protection undergoing intracranial aneurysm clipping.Methods:ASAⅡ～Ⅲ grade intracranial aneurysm clipping surgery with30cases in our hospital,were randomly divided into two groups(n=15cases),respectively the group D(Deeper anesthesia,whose BIS maintained between20to40)and the group L(Lighter anesthesia,whose BIS maintained between40to60).The technology of total intravenous anesthesia were used to induct and maintain during the surgery,use the bispectral index score feedback control target infusion propofol to adjust the depth of anesthesia for group D and group L. Punctured the radial artery and the jugular vein before anesthesia under local anesthesia.Respectively write down vital signs (such as HR、MAP、 ECG、SpO2, and so on),blood or fluid transfusion and the use of propofol At the before anesthesia(T0)、 the moment of intubation tube induction and succeed (T1)、the moment of cutting duramater (T2)、the moment of ligaturing the intracranial aneurysm(T3)、end off the surgery(T4)five time points; Collect jugular bulb blood and artery blood to do gas analysis and S100β protein detection at the To、T1、T2、T3、T4five time points,then calculated the arteriovenous oxygen saturation;Finally analyse the trend changes among the S100β protein, jugular venous oxygen saturation and arteriovenous oxygen saturation.Intraoperative awareness were followed up.Results:There is no intraoperative awareness occurred during the surgery in our postperative follow-up visits. Haemodymamics changes:the MAP of group D decreased at T1is more apparent,there were significant differences(P=0.047);HR changes are stable in both two groups, there is no significant differences between interblock comparison (P>0.05).The target plasma concentration and the use amount of propofol are statistical significance(P<0.05).S100β protein concentration in T2、T3and T4were significantly increased compared with To between the two groups(P<0.05);there is no significant differences between groups at T0、 T1,Group L in T2、T3、T4time points had increased were statistically significant among them(P=0.0145～0.0317),the value of the group L are more than group D.Aspects of cerebral oxygen metabolism:(l)SjvO2:There is statistically significant (P<0.05)at the T1in two groups; T3、T4time points were lower than To in group L (P=0.0379,0.0258);Group D is higher than group L,but there are statistically significant at T3、T4time points(P<0.05);(2)AVDO2:There is statistically significant (P<0.05)at the T1in two groups; The T4time points were higher than To in group L (P=0.0152);Group D is lower than group L,but there is statistically significant at T4time point (P<0.05)Conclusions:1.Deeper anesthesia can lower the S100β protein and the rate of cerebral oxygen metabolism, decrease the imbalance of cerebral oxygen demand and supply in intracranial aneurysm clipping surgery.2.Deeper anesthesia(whose BIS maintained between20to40)play the better role on cerebral protection in intracranial aneurysm clipping surgery.