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| Effects of Intravenous Anesthesia with Etomidate and Propofol on Cerebral Oxygen Metabolism in Patients with Subdural Hematoma |
| ZHANG Changwei, et al |
| Nantong First People's Hospital, Jiangsu Nantong 226001, China |
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Abstract Objective: To investigate the effects of intravenous anesthesia with etomidate and propofol on hematoma evacuation in patients with subdural hematoma. Methods: 86 patients with subdural hematoma from August 2016 to June 2018 were enrolled in our hospital, divided into etomidate group (n=43) and propofol group (n=43) as the simple random grouping and proceeded hematoma evacuation treatment. The propofol group was intravenously anesthetized with propofol, and the etomidate group was given intravenous anesthesia with etomidate. The two groups were analyzed before anesthesia induction (T0), after intubation (T1), 30 min (T2), and (T3) hemodynamics [mean arterial pressure (MAP), heart rate (HR)]. Cerebral oxygen metabolism index [CEO2, cervical internal venous oxygen saturation (SjvO2)] level, S100β protein level, lactic acid internal jugular venous lactic acid (Ljv), arterial blood lactate (La) level and adverse reactions incidence were compared. Results: Hemodynamics: There was no significant difference in MAP and HR levels between the two groups (P>0.05). The T1 and T3 were significantly lower in the propofol group than in the T0 period (P<0.05). T1, T2 There was no significant change in MAP and HR levels in the etomidate group compared with the T0 period (P>0.05), and the MAP in the propofol group was lower than that in the etomidate group at each time point after induction (P<0.05). Cerebral oxygen metabolism: There was no significant difference between CERO2 and SjvO2 levels in the T0 period (P>0.05). The levels of SjvO2 in the T1, T2 and T3 groups were higher than those in the T0 period, and the CERO2 level was lower than that in the T0 period, and the propofol group SjvO2 The level of CERO2 was lower than that of etomidate group (P<0.05). There was no significant difference between S100β protein levels in S100β protein:T0 period (P>0.05), T1, T2, T3 The levels of S100β protein in the two groups were higher than those in the T0 period, but the level of S100β protein in the propofol group was lower than that in the etomidate group (P<0.05). There was no significant difference in Ljv and La levels between the two groups during the T0 period. (P>0.05), there was no significant change in Ljv, La level and T0 period between T1, T2 and T3 (P>0.05). There was no significant difference between the groups (P>0.05); Adverse reactions: There was no significant difference between the incidence of adverse reactions in the propofol group (16.28%) and the etomidate group (11.63%) (P>0.05). Conclusions: Intravenous anesthesia with propofol and etomidate in patients with epidural hematoma during hematoma clearance can not lead to abnormal fluctuation of lactic acid level and has high safety, but etomidate has significant advantages in maintaining hemodynamic stability. Propofol can improve brain metabolism, protect brain and inhibit abnormal increase of S100beta protein level.
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2019, Vol. 25 
