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Title: Systemic haemodynamic, renal perfusion and renal oxygenation responses to changes in inspired oxygen fraction during total intravenous or volatile anaesthesia.
Austin Authors: Iguchi, Naoya;Kosaka, Junko;Iguchi, Yoko;Evans, Roger G;Bellomo, Rinaldo ;May, Clive N;Lankadeva, Yugeesh R
Affiliation: Department of Anaesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka University, Japan
Department of Anaesthesiology, Saiseikai Senri Hospital, Osaka, Japan
Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
Preclinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, Australia
Intensive Care
Issue Date: Aug-2020 2020-06-18
Publication information: British Journal of Anaesthesia 2020; 125(2): 192-200
Abstract: Anaesthesia-induced changes in renal perfusion are dependent on the choice of anaesthetic agent. However, the effects of varying inspired oxygen fraction (FiO2) on renal perfusion and oxygenation during TIVA (propofol + fentanyl) or volatile anaesthesia (VA; isoflurane) are unknown. In 16 Merino ewes, we surgically implanted a renal artery flow probe and laser-Doppler and oxygen-sensing probes in the renal medulla and cortex. We compared the systemic and renal effects of graded alterations in FiO2 (0.21, 0.40, 0.60, and 1.0) during TIVA or VA and compared the changes with those in the non-anaesthetised state. Compared with the non-anaesthetised state, TIVA and VA decreased renal blood flow (-50% vs -75%), renal oxygen delivery (-50% vs -80%), and renal cortical (-40% vs -60%) and medullary perfusion (-50% vs -75%). At an FiO2 of 0.21, both anaesthetic regimens induced similar reductions in cortical (-58 vs -65%) and medullary (-37% vs -38%) oxygenation. At higher concentrations of FiO2, renal blood flow and renal tissue perfusion were not changed, but intrarenal oxygenation improved similarly under TIVA and VA. In particular, at an FiO2 of ≥0.40 and ≤0.60, cortical and medullary oxygen tension were similar to the non-anaesthetised state. Irrespective of FiO2, TIVA decreased renal and intrarenal perfusion less than VA, but at low FiO2 concentrations both led to equivalent reductions in renal cortical and medullary oxygenation. However, with FiO2 between 0.40 and 0.60 during TIVA or VA, both cortical and medullary oxygenation was maintained at normal physiological levels.
DOI: 10.1016/j.bja.2020.03.033
ORCID: 0000-0002-1650-8939
PubMed URL: 32563492
Type: Journal Article
Subjects: TIVA
renal oxygenation
renal perfusion
systemic haemodynamics
volatile anaesthesia
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