The effect of desflurane combined with propofol on cerebral oxygen metabolism and energy metabolism during revascularization of moyamoya disease

Objective To investigate the effect of desflurane combined with propofol on cerebral metabolism and energy metabolism during revascularization of moyamoya disease.Methods Twenty ASAⅠ-Ⅱpatients aged 18 to 60 years undergoing elective revascularization surgery were enrolled in the study.Anesthesia was induced with etomidate 0.3 mg/kg,sufentanil 0.4-0.5μg/kg and cis-atracurium 0.15-0.2 mg/kg.Anesthesia was maintained with desflurane-propofol MCI 2.5 mg/(kg h)combined with remifentanil MCI 0.1-0.3μg/(kg min).Adjust the concentration of desflurane to maintain the BIS value at 40-60.Blood gas analysis,glucose,lactate were detect in blood sample from bulb of internal jugular vein and peripheral artery at 10 min after induction of anesthesia(T1),30 min after surgery(T2),10 min before blood vessel was clamped(T3),20 min after blood vessel was clamped(T4)and end of surgery(T5).Cerebral oxygen extraction ration(CERO2),arterio-venous oxygen content difference(Da-jvO2),glucose extraction ration(CERGlu)and difference of bulb of jugular vein and artery lactic acid(Djv-aLac)were calculated.Results Compared with T3 and T4,Da-jvO2 was decreased at T 5(all P<0.05).Compared with T 2,Djv-aLac was decreased at T 3 and T 5(all P<0.05).There were no difference in SjvO2,CERO 2,Glua,Glujv,Laca,Lacjv and CERGlu at each time point(all P>0.05).Conclusion Desflurane combined with propofol anesthesia can not only maintain a balance of cerebral oxygen supply and demand but blood glucose and blood lactate stable for revascularization for moyamoya disease.