Abstract:

Objective To compare the effects of different severities of malignant anemia on anesthetic efficacy of sevoflurane based-inhalational anesthesia and propofol intravenous anesthesia. Methods A total of 120 patients undergoing elective laparoscopic surgery during genneral anesthesia at our hospital were enrolled in this prospective study.Patients were divided into three groups based on preoperative hemoglobin level：normal hemoglobin （n=40，Hb≧120 g/L），mild anemia （n=40，90≤Hb<120 g/L），and moderate anemia （n=40，60≤Hb<90 g/L）. Patients were also divided into one group that received sevoflurane inhalation anesthesia（n=20） and one group that received intravenous anesthesia with propofol （n=20）. Pulse oxygen saturation （SpO₂），mean blood pressure （MBP），heart rate （HR） and bispectral index （BIS） were recorded before induction （T1），before intubation （T2），at intubation （T3），at pneumoperitoneum （T4），at extubation （T5） and 2 h after operation （T6）. Data were recorded on pneumoperitoneum pressure and duration，hemorrhage volume，transfusion volume of fluid and blood，vasoactive therapy，propofol or sevoflurane dosage，time to open eyes，time to intubation，incidence of postoperative agitation，and incidence of postoperative nausea and vomiting. Serum levels of cortisol and 5-serotonin （5-HT） were assessed using enzyme-linked immunosorbent assay. Results Dosage of sevoflurane was similar across the normal hemoglobin，mild anemia and moderate anemia subgroups among patients receiving sevoflurane.In contrast，propofol dosage differed significantly between the normal hemoglobin and moderate anemia subgroups. Patients receiving sevoflurane showed significantly shorter time to eye opening than those receiving propofol，but they also showed significantly higher incidence of postoperative nausea，vomiting and dysphoria.Cortisol and 5-HT concentrations were significantly higher at T3 and T5 than at T1，while levels were significantly lower at T2 than at T1. Conclusions Sevoflurane inhalation anesthesia was associated with faster revival but also higher incidence of postoperative nausea，vomiting and dysphoria than intravenous anesthesia.Moderate anemia was associated with lower propofol dosage and volatile hemodynamics.

Key words: Malignant anemia, Sevoflurane, Propofol, Anesthetic efficacy, Preoperative hemoglobin