Effects Of Different Anesthetic Maintenance On Patients Undergoing Intracranial Aneurysm Clipping

Objective:To investigate the effects of different anesthetic maintenance on hemodynamic, cerebral oxygen metabolism, stress hormone level and S100β during operation of intracranial aneurysm clipping, and to discuss which is better for those patients.Methods:Thirty adult patients scheduled for intracranial aneurysm clipping,according to different anesthetic maintenance,were randomly divided into two groups(n=15):Group S and Group P. Group S was mainly given analgesic drugs-sufentanil,while group P was mainly given sedative drugs-propofol. After anesthesia induction the total dosage of sufentanil and propofol, fluid volume of intaken and urine, and the operration time(OPT) were recorded, respectively. The changes of PETCO2、HR、MAP and SSP were recorded at the completion of the internal jugular vein retrograde catheter (T1),the moment of installing head frame(T2),the moment of cutting scalp(T3),the moment of drilling skull(T4),the moment of opening the duramater(T5),the moment of closing the duramater(T6) and the end of operation(T7). The outcomes of PaO2, PsvO2, SaO2, SsvO2, HB, Glu and Lactic acid were acquired from blood gas analysis,whose blood samples were synchronously taken from radial artery and the sigmoid sinus venous at the completion of the internal jugular vein retrograde catheter (T1), the moment of opening the duramater(T5), the moment of closing the duramater(T6), the end of operation(T7) and4h after operation(T8). CaO2, CsvO2, Da-svO2, CERO2were respectively calculated according to FiCK formula. Quantity of IL-6、NE、COR and S100β were detected from intracranial venous blood extracted at T1, T5, T6, T7,T8and T9(48h after operation).Results:(1)There were significant difference in the dosage of sufentanil and propofol between the two groups(P<0.01).After anesthesia induction,the total sufentanil dosage in group S is about three times of that in group P,while the total propofol dosage in group P is about two times of that in group S. There were no significant difference in fluid volume of intaken and urine between the two groups (P>0.05).(2) Hemodynamic changes:①Comparison within-group:Compared with the point at Tl,the HR at point T5, T6, T7is statistically reduced in group S(P<0.05),while there was no significant statistical difference in group P(P>0.05). Compared with Tl,the MAP at point T2and T3were statistically elevated in both groups(P<0.05). Compared with Tl,the SSP at other points had no significant statistical difference in group S(P>0.05), while SSP at point T5and T6were significant reduced in group P(P<0.05).②Comparison between-groups:Compared with group P at the corresponding point, HR of group S at the point T4,T5,T6were statistically reduced (P<0.05).Both MAP and SSP at the corresponding point had no significant difference between the two groups (P>0.05).(3) Blood gas changes:①Comparison within-group:Compared with T1,GLU at point T5,T6,T7were significantly elevated in both groups(P<0.05). Compared with T1,HB at point T5,T6,T7were significantly reduced in both groups(P<0.05).The changes of LAC were of no statistical difference in both groups(P>0.05). Compared with T1, SsvO2at point T5was significantly reduced in group S(P<0.05). Compared with T1, Da-svO2and CERO2at point T5, T6and T7were significantly elevated in group S(P<0.05).There were no statistical difference in Da-svO2and CER02in group P(P>0.05).②Comparison between-groups:There were no statistical difference in GLU, LAC, HB, CaO2, CsvO2, Da-svO2and CERO2between groups(P>0.05). Compared with group S at the corresponding point, SsvO2at point P6in group P was higher(P<0.05).(4) Stress index and S100β:①Comparison within-group:Compared with Tl,there were no statistical difference in IL-6,NA,S100βin both groups (P>0.05). Compared with Tl, COR at point T5,T6,T7and T8in group S were significantly reduced (P<0.05), while COR at point T7and T8in group P were significantly reduced(P<0.05).②Comparison between-groups:Compared with group S at the corresponding point, IL-6at point T5,T6and T8in group P were statistically higher (P<0.05).Compared with group S,NE at point T5,T6,T8and T9in group P were statistically higher (P<0.05). There were no statistical difference in COR and S100β between groups (P>0.05).Conclusion:In this study, we can conclude as follows:(1) There were no statistical difference in the effect of different anesthetic maintenance on cerebral oxygen metabolism, S100β and COR level during operation of intracranial aneurysm clipping.(2) There were significant difference in the effect of different anesthetic maintenance on IL-6and NE level during operation of intracranial aneurysm clipping. Compared with group S,IL-6and NE in group P were statistically higher(P<0.05), in terms of which, group S that was mainly given analgesic drugs-sufentanil is the better choice.