Effects of remifentanil and propofol TCI anesthesia on cerebral oxygen metabolism in surgery of cerebral tumor

Objective: To explore the effects of remifentanil and propofol TCI anesthesia on cerebral oxygen metabolism in surgery of brain tumor patients with isoflurane balanced anesthesia.Methods: 36 ASA Ⅰto Ⅱelective intra-cranial tumor patients were randomly divided into the isoflurane balanced anesthesia group(C group)(n=15) and the TCI group(R group)(n=21).Patients in the R group were inducted by propofol TCI with plasma concentration 3 μg/ml and remifentanil TCI with plasma concentration 6 ng/ml and they were maintained with remifentanil and propofol TCI anesthesia.The plasma concentrations were determined based on the stimulus and patients′ response in the surgeryprocedure.Patients in the C group were inducted by propofol 2 mg/kg,fentanyl 0.2 μg/kg and vecuronium 0.1 mg/kg-1.After intubation,1% to 2% isoflurane and vecuronium were administered based on the stimulus and patients′ response in the surgery procedure.The BP,HR,SpO2 and PETCO2 were determined at pre-induction(T1),intubation(T2), 5 min after intubation(T3),slicing the duramater(T4),30 min after removing the tumor(T5),the end of the operation(T6)and extubation(T7) and the recover time was also determined.Meanwhile the SjvO2 and Da-jvO2 were determined at pre-induction(t1),30 min after induction(t2),1 h after induction(t3),2 h after induction(t4),and extubation(t5).Results: Patients′ BP,HR,SpO2 and PETCO2 were similar between the two groups(P0.05).In both groups,patients′ BP significantly decreased after induction(P0.05).Patients in the C group recovered more slowly than those in the R group(P0.05).SjvO2 of the C group was higher than that of the R group,while Ca-jvDO2 of the C group was lower than that of the R group at time of t2,t3 and t4(P0.05).SjvO2 at t2,t3 and t4 was higher than that at t1,while Da-jvO2 at t2,t3 and t4 was lower than that at t1 in the C group(P0.05).Conclusions: Both remifentanil and propofol TCI anesthesia and isoflurane balanced anesthesia can maintain smooth life signs in surgery of cerebral tumor patients.Patients anesthetized with remifentanil and propofol TCI recover more quickly than those anesthetized with isoflurane balanced anesthesia.Remifentanil and propofol TCI anesthesia can balance the oxygen supply consumption better than isoflurane balanced anesthesia do during the operation.