Differences in PCO2, pH, Lactate, K + and Na+ Between Arterial Blood and Jugular Bulb Blood in Patients Subjected to Craniotomy in Either Propofol-Fentanyl or Propofol-Remifentanil Anaesthesia

  • Niels Juul
  • Georg E. Cold


Studies of intensive care patients indicate that the arteriovenous difference (AVD) of PCO2 in the systemic circulation increases during critical hypoperfusion. As regards the cerebral circulation, studies in pigs indicate that the AVD-PCO2 increases with CBF reduction. In patients subjected to craniotomy for supratentorial cerebral tumours the AVD-PCO2 or AVD-pH has not been studied. It has repeatedly been documented that low values of jugular bulb oxygen saturation (SjO2) and high values of AVDO2 occur during anaesthesia with propofol-fentanyl or propofol-alfentanil, and in a comparative study of propofol-fentanyl or propofol-remifentanil anaesthesia SjO2 is even lower during the latter. In this chapter, the results of a database study of AVD of physiological parameters are reported and discussed. We investigated the relationships between AVDO2, AVD-PCO2, AVD-pH, AVD of the electrolytes Na+, K+ and Ca++, SjO2, jugular oxygen content and jugular oxygen tension during maintenance anaesthesia with propofol-fentanyl and propofol-remifentanil.


Cerebral Ischaemia Global Cerebral Ischaemia Jugular Bulb Maintenance Anaesthesia Equal Variance Test 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Chieregato A, Zoppellari R, Targa L (1997) Cerebral arteriovenous PCO2 difference and early global cerebral ischaemia in patients with severe head injury. J Neurosurg Anesthesiol 9:256–262PubMedCrossRefGoogle Scholar
  2. Chieregato A, Calzolari F, Trasforini G et al (2003) Normal jugular bulb oxygen saturation. J Neurol Neurosurg Psychiatry 74:784–786PubMedCrossRefGoogle Scholar
  3. Datsur DK, Lane MH, Hansen DB et al (1963) Effects of aging on cerebral circulation and metabolism in man. In: Birren JE, Butler RN, Greenhouse SW et al (eds) Human aging. A biological and behavioral study. US Government Printing Office, Washington, DC, pp 59–76Google Scholar
  4. Gibbs EL, Lennox WG, Nims LF et al (1942) Arterial and cerebral venous blood. Arterio- venous differences in man. J Biol Chem 144:325–332Google Scholar
  5. Jakobsen M, Enevoldsen E (1989) Retrograde catheterization of the right internal jugular vein for serial measurements of cerebral venous oxygen content. J Cereb Blood Flow Metab 9:717–720PubMedGoogle Scholar
  6. Jansen GF, van Praagh BH, Kedaria MB et al (1999) Jugular bulb oxygen saturation during propofol and isoflurane/nitrous oxide anesthesia in patients undergoing brain tumour surgery. Anesth Analg 89:358–363PubMedCrossRefGoogle Scholar
  7. Kuwano Y, Kawaguchi M, Inoue S et al (2004) Jugular bulb oxygen saturation under propofol or sevoflurane/nitrous oxide anesthesia during deliberate mild hypothermia in neurosurgical patients. J Neurosurg Anesthesiol 16:6–10CrossRefGoogle Scholar
  8. Manohar M (1986) Regional brain blood flow and cerebral cortical O2 consumption during sevoflurane anesthesia in healthy isocapnic swine. J Cardiovasc Pharmacol 8:1268–1275PubMedCrossRefGoogle Scholar
  9. Mekontso-Dessap A, Castclain V, Anguel N et al (2002) Combination of venoarterial PCO2 difference with arterio-venous O2 content difference to detect anaerobic metabolism in patients. Intensive Care Med 28:272–277PubMedCrossRefGoogle Scholar
  10. Mielck F, Stephan H, Weyland A et al (1999) Effects of one minimum alveolar anesthetic concentration sevoflurane on cerebral metabolism, blood flow, and CO2 reactivity in cardiac patients. Anesth Analg 89:364–369PubMedCrossRefGoogle Scholar
  11. Moss E, Dearden NM, Berridge JC (1995) Effects of changes in mean arterial pressure on SjO2 during cerebral aneurysm surgery. Br J Anaesth 75:527–530PubMedGoogle Scholar
  12. Nandate K, Vuylsteke A, Ratsep I et al (2000) Effects of isoflurane, sevoflurane and propofol anaesthesia on jugular venous oxygen saturation in patients undergoing coronary artery by-pass surgery. Br J Anaesth 84:631–633PubMedGoogle Scholar
  13. Petersen KD, Landsfeldt U, Cold GE et al (2003) Intracranial pressure and cerebral hemodynamic in patients with cerebral tumours. Anesthesiology 98:329–336PubMedCrossRefGoogle Scholar
  14. Rossi S, Colombo A, Magnoni S et al (2002) Cerebral veno-arterial pCO2 difference as an estimator of uncompensated cerebral hypoperfusion. Acta Neurochir Suppl 81:201–204PubMedGoogle Scholar
  15. Scheller MS, Tateichi A, Drummond JC et al (1988) The effects of sevoflurane on cerebral blood flow, cerebral metabolic rate of oxygen, intracranial pressure, and the electroencephalogram are similar to those of isoflurane in the rabbits. Anesthesiology 68:548–551PubMedCrossRefGoogle Scholar
  16. Scheller MS, Nakakimura K, Fleischer JE et al (1990) Cerebral effects of sevoflurane in the dog: comparison with isoflurane and enflurane. Br J Anaesth 65:388–392PubMedCrossRefGoogle Scholar
  17. Stiefel MF, Tomita Y, Marmarou A (2005) Secondary ischemia impairing the restoration of ion homeostasis following traumatic brain injury. J Neurosurg 103:707–714PubMedCrossRefGoogle Scholar
  18. Stocchetti N, Zanier ER, Nicolini R et al (2005) Oxygen and carbon dioxide in the cerebral circulation during progression of brain death. Anesthesiology 103:957–961PubMedCrossRefGoogle Scholar
  19. Zhang H, Vincent JL (1993) Ateriovenous differences of PCO2 and pH are good indicators of critical hypoperfusion. Am Rev Respir Dis 148:867–871PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2008

Authors and Affiliations

  • Niels Juul
    • 1
  • Georg E. Cold
    • 2
  1. 1.Department of NeuroanaesthesiaAarhus University HospitalAarhus CDenmark
  2. 2.Aarhus VDenmark

Personalised recommendations