Changes in blood oxygen transport function and body energy expenditure during anaesthesia during coronary artery bypass grafting in adults: A randomized clinical study

Bekzat Baiterek 1 2 * , Alibek Mustafin 1 2 3
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1 Department of Anesthesiology and Intensive Care, Astana Medical University, Astana, Kazakhstan
2 Anesthesiology, Resuscitation and Intensive Care Unit, City Multidisciplinary Hospital No 2, Astana, Kazakhstan
3 Anesthesiology, Resuscitation and Intensive Care Unit, Medical Centre Hospital of President’s Affairs Administration of the Republic of Kazakhstan, Astana, Kazakhstan
* Corresponding Author
J CLIN MED KAZ, Volume 20, Issue 6, pp. 60-65. https://doi.org/10.23950/jcmk/13944
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ABSTRACT

Introduction: Cardiac surgery is a dangerous and complex field of medicine with significant morbidity and mortality. Quality anesthetic care with specific attention to detail can greatly enhance patient safety and outcome.
Objectives: Comparison of the effects of anesthetics on oxygen consumption, transport and energy expenditure during coronary artery bypass grafting in adults.
Material and methods: A total of 90 patients were assigned randomly into three groups according to the type of anaesthesia: the first group with propofol (P), the second group with sevoflurane, and the last one was with isoflurane. All patients underwent coronary artery bypass grafting under cardiopulmonary bypass. To determine oxygen delivery and oxygen consumption were determined using the formulas ((DO2 = CI* CaO2), (VO2 = Cardiac index (CI)) and a spirometric device during anaesthesia.
Results: the cardiac index remained at the same level in the propofol and sevoflurane groups (2.5±0.6 l/min/m2 and 2.3±0.5 l/min/m2), while in the isoflurane group it was decreased to 2.3±0.5 l/min/m2. The oxygen transport index was 421.6±57.0 ml/min/m2 in the propofol group, 396.4±63.2 ml/min/m2 in the sevoflurane group, and 376.7±68.0 ml/min/m2 in the isoflurane group. Propofol reduced oxygen consumption to 101.5±23.5 ml/min/m2, while sevoflurane and isoflurane anesthesia reduced it to 106.6±22.3 ml/min/m2 and 116.4±21.4 ml/min/ m2. All anaesthetics reduced energy expenditure, but propofol anaesthesia significantly reduced it from 1491.4 to 1188.3 kcal/day.
Conclusion: In conclusion, isoflurane significantly reduced cardiac index compared to propofol and sevoflurane. Oxygen transport was higher in the propofol group than volatile anesthetics, and propofol reduced oxygen consumption more than inhalational anesthetics. In addition, energy expenditure was lowest in the propofol group than in the other anesthetics.
Keywords: Oxygen consumption, energy expenditure, sevoflurane, isoflurane, propofol, oxygen transport, metabolic status.

CITATION

Baiterek B, Mustafin A. Changes in blood oxygen transport function and body energy expenditure during anaesthesia during coronary artery bypass grafting in adults: A randomized clinical study. J CLIN MED KAZ. 2023;20(6):60-5. https://doi.org/10.23950/jcmk/13944

REFERENCES

  • Alfredo Abad Gurumeta Teresa Lopez Quesada M. Ortega Urbaneja L. Olidén Gutiérrez. Clinical utility and metabolic monitoring of oxygen consumption in anesthesia. Actualizaciones en Anestesiologia y Reanimacion. 2010; 20(4):150-154.
  • Hulbert AJ, Else PL. Basal metabolic rate: history, composition, regulation, and usefulness. Physiol Biochem Zool. 2004; 77(6):869-76. https://doi.org/10.1086/422768
  • Secor SM. Specific dynamic action: a review of the postprandial metabolic response. J Comp Physiol B. 2008; 179(1):1-56. https://doi.org/10.1007/s00360-008-0283-7
  • Desborough JP. The stress response to trauma and surgery. BJA: British Journal of Anaesthesia. 2000; 1 (85):109-117. https://doi.org/10.1093/bja/85.1.109
  • Older P, Smith R. Experience with the preoperative invasive measurement of haemodynamic, respiratory and renal function in 100 elderly patients scheduled for major abdominal surgery. Anaesth Intensive Care. 1988; 16(4):389-95. https://doi.org/10.1177/0310057X8801600402
  • Waxman K. Hemodynamic and metabolic changes during and following operation. Crit Care Clin. 1987; 3(2):241-50. https://doi.org/10.1016/S0749-0704(18)30544-X
  • Alazawi W, Pirmadjid N, Lahiri R, Bhattacharya S. Inflammatory and Immune Responses to Surgery and Their Clinical Impact. Ann Surg. 2016; 264(1):73-80. https://doi.org/10.1097/SLA.0000000000001691
  • Takenaka K, Ogawa E, Wada H, Hirata T. Systemic inflammatory response syndrome and surgical stress in thoracic surgery. J Crit Care. 2006; 21(1):48-53 discussion53-5. https://doi.org/10.1016/j.jcrc.2005.07.001
  • Tánczos K, Molnár Z. The oxygen supply-demand balance: a monitoring challenge. Best Pract Res Clin Anaesthesiol. 2013; 27(2):201-7. https://doi.org/10.1016/j.bpa.2013.06.001
  • R. M. Leach, D. F. Treacher. Oxygen transport-2. Tissue hypoxia. BMJ. 1998; 317(7169):1370-3. https://doi.org/10.1136/bmj.317.7169.1370
  • Julia Jakobsson, Sofia Vadman, Eva Hage, Sigridur Kalman, Erzsébet Bartha. The effects of general anaesthesia on oxygen consumption: A meta-analysis guiding future studies on perioperative oxygen transport. Acta Anaesthesiol Scand. 2019; 63(2):144-153. https://doi.org/10.1111/aas.13265
  • G. K. Ogilvie, M. D. Salman, M. L. Kesel, M. J. Fettman. Effect of anesthesia and surgery on energy expenditure determined by indirect calorimetry in dogs with malignant and nonmalignant conditions. Am J Vet Res. 1996; 57(9):1321-6.
  • H. E. Taylor, K. Simons, C. Willmott, R. E. R. Smith & D. E. P. Bramley. A feasibility study to investigate post-operative oxygen consumption (POpOC) after colorectal surgery requiring bowel resection. Pilot and Feasibility Studies. 2019; 5. https://doi.org/10.1186/s40814-019-0477-7
  • Julia Jakobsson, Carl Norén, Eva Hagel, Sigridur Kalman, Erzsébet Bartha. Peri-operative oxygen consumption revisited: An observational study in elderly patients undergoing major abdominal surgery. Eur J Anaesthesiol. 2021; 38(1):4-12. https://doi.org/10.1097/EJA.0000000000001302
  • Tae Soo Hahm, Heejoon Jeong and Hyun Joo Ahn. Systemic Oxygen Delivery during One-Lung Ventilation: Comparison between Propofol and Sevoflurane Anaesthesia in a Randomised Controlled Trial. J. Clin. Med. 2019; 8(9):1438. https://doi.org/10.3390/jcm8091438
  • A. Bacher, U. M. Illievich, R. Fitzgerald, G. Ihra, C. K. Spiss. Changes in oxygenation variables during progressive hypothermia in anesthetized patients. J Neurosurg Anesthesiol. 1997; 9(3):205-10. https://doi.org/10.1097/00008506-199707000-00001
  • D. Hausmann, J. Nadstawek, W. Krajewski. O2 uptake in the recovery period. The effect of the anesthetic procedure and the postoperative administration of pethidine. Anaesthesist. 1991; 40(4):229-34.
  • Alfredo Abad Gurumeta,Teresa Lopez Quesada. Clinical utility and metabolic monitoring of oxygen consumption in anesthesia. Actualizaciones en Anesthesiologia y Reanimacion. 2010; 20(4):150-154.
  • A.S. YUDINA, E.V. FOT, M.YU. KIROV. Evaluation of integrated pulmonary index in patients with cardiac diseases undergoing ophthalmic surgery. Russian Journal of Anaesthesiology and Reanimatology. 2020; 2:48-54. https://doi.org/10.17116/anaesthesiology202002148
  • F. de Wit, A. L. van Vliet, R. B. de Wilde, J. R. Jansen, J. Vuyk, L. P. Aarts, E. de Jonge, D. P. Veelo, B. F. Geerts. The effect of propofol on haemodynamics: cardiac output, venous return, mean systemic filling pressure, and vascular resistances. BJA: British Journal of Anaesthesia. 2016; 6(116):784-789. https://doi.org/10.1093/bja/aew126
  • S J Barker, D M Gamel, K K Tremper. Cardiovascular effects of anesthesia and operation. Crit Care Clin. 1987; 3(2):251-68. https://doi.org/10.1016/S0749-0704(18)30545-1
  • T J Ebert, C P Harkin, M Muzi. Cardiovascular responses to sevoflurane: a review. Anesth Analg. 1995; 81(6 Suppl):S11-22. https://doi.org/10.1097/00000539-199512001-00003
  • Dodiyi-Manuel Sotonye Tamunobelema, Christian Ifeanyi Uruaka (2023). General Anaesthetic Agents and Their Implication on the Cardiovascular System: A Systematic Review. Saudi J Med Pharm Sci. 2023; 9(3):171-184. https://doi.org/10.36348/SJMPS
  • Tae Soo Hahm. Heejoon Jeong. Hyun Joo Ahn. Systemic Oxygen Delivery during One-Lung Ventilation: Comparison between Propofol and Sevoflurane Anaesthesia in a Randomised Controlled Trial. J. Clin. Med. 2019; 8(9):1438. https://doi.org/10.3390/jcm8091438
  • O. Pruszkowski, N. Dalibon, M. Moutafis, E. Jugan, J. D. Law-Koune, P. A. Laloë, M. Fischler. Effects of propofol vs sevoflurane on arterial oxygenation during one-lung ventilation. BJA: British Journal of Anaesthesia. 2007; 4(98):539-544. https://doi.org/10.1093/bja/aem039
  • Luisa Briesenick, Annika Schaade, Alina Bergholz, Phillip Hoppe, Karim Kouz, Linda Krause, Moritz Flick, Bernd Saugel. Energy Expenditure Under General Anesthesia: An Observational Study Using Indirect Calorimetry in Patients Having Noncardiac Surgery. Anesth Analg. 2023; 137(1):169-175. https://doi.org/10.1213/ANE.0000000000006343