BJA Advance Access published online on June 3, 2008
British Journal of Anaesthesia, doi:10.1093/bja/aen136
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Effects of remifentanil-based general anaesthesia with propofol or sevoflurane on muscle microcirculation as assessed by near-infrared spectroscopy
Department of Anaesthesiology and Intensive Care, University of Rome ‘La Sapienza’, Second Faculty of Medicine, Sant’Andrea Hospital, Rome, Italy
* Corresponding author. E-mail: radbl{at}libero.it
Background: Although anaesthetics are known to alter microcirculation no study has, to our knowledge, documented changes in human skeletal microcirculatory function during general anaesthesia.
Methods: Forty-four patients undergoing maxillofacial surgery at a university hospital were prospectively randomized to receive general anaesthesia with remifentanil combined with propofol or sevoflurane. Muscle microcirculation was investigated with near-infrared spectroscopy (NIRS) before general anaesthesia was induced and 30 min later. An NIRS device (NIMO, Nirox) was used to quantify calf deoxyhaemoglobin [HHb], oxyhaemoglobin [HbO2], and total haemoglobin [HbT] concentrations, coupled to a series of venous and arterial occlusions to measure calf blood flow, muscle oxygen consumption, calf vascular resistance, microvascular compliance, and haemoglobin resaturation rate (RR).
Results: In both the groups, general anaesthesia induced marked changes in muscle microcirculation: the tissue blood volume increased (+33% in remifentanil–sevoflurane and +45% with remifentanil–propofol groups), microvascular resistance decreased (–31% and –38%, respectively), and the post-ischaemic haemoglobin RR decreased (–48% and –36%, respectively). In the remifentanil–propofol group, the muscle blood flow increased (P<0.001), whereas in the remifentanil–sevoflurane group microvascular compliance and muscle oxygen consumption decreased (P<0.01).
Conclusions: Remifentanil-based general anaesthesia with propofol or sevoflurane altered the muscle microcirculation in different ways. Quantitative NIRS, a technique that takes into account the optical tissue properties of the individual subject, can effectively measure these changes non-invasively.
Keywords: anaesthesia, general; anaesthetics volatile, sevoflurane; microcirculation; propofol
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