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Effects of sevoflurane versus propofol on cerebral autoregulation during anaesthesia for robot-assisted laparoscopic prostatectomy.

Authors
  • Robertson, Tomas J1
  • McCulloch, Timothy J1, 2
  • Paleologos, Michael S1, 2
  • Downey, Ryan G1, 2
  • Loadsman, John A1, 2
  • Thanigasalam, Ruban1, 3
  • Leslie, Scott1, 3
  • 1 Sydney Medical School, University of Sydney, Sydney, Australia. , (Australia)
  • 2 Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, Australia. , (Australia)
  • 3 Department of Urology, Chris O'Brien Lifehouse, Camperdown, Australia. , (Australia)
Type
Published Article
Journal
Anaesthesia and intensive care
Publication Date
May 15, 2022
Identifiers
DOI: 10.1177/0310057X211061158
PMID: 35574717
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Robot-assisted laparoscopic prostatectomy requires a pneumoperitoneum combined with steep Trendelenburg positioning, and these conditions can be associated with impairment of cerebral autoregulation. The objective of this study was to determine if choice of anaesthetic agent affects the preservation of cerebral autoregulation during robot-assisted laparoscopic prostatectomy. We randomly assigned 30 patients to maintenance of general anaesthesia with either propofol or sevoflurane. Cerebral autoregulation was tested by administration of intravenous phenylephrine to increase mean arterial pressure from approximately 80 mmHg to 100 mmHg while assessing cerebral blood flow using transcranial Doppler ultrasonography. Autoregulation was first tested in the supine position and then approximately once every hour after Trendelenburg positioning. The main outcome measure was the result of the final autoregulation test prior to completion of surgery. At that time, we found cerebral autoregulation to be significantly impaired in six of the 15 patients receiving sevoflurane and none of the 15 patients receiving propofol (P = 0.02). However, it should be noted that some patients in the propofol group had impaired autoregulation on earlier tests. In conclusion, we found that autoregulation during robot-assisted laparoscopic prostatectomy is less likely to be impaired with propofol compared to sevoflurane anaesthesia, particularly towards the end of the surgery.

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