A comparative study of sevoflurane sedation with tci propofol sedation in dialysis dependent end stage renal failure patients for transposition of brachiocephalic fistula repair / Lee Wen Xin

Lee , Wen Xin (2024) A comparative study of sevoflurane sedation with tci propofol sedation in dialysis dependent end stage renal failure patients for transposition of brachiocephalic fistula repair / Lee Wen Xin. Masters thesis, Universiti Malaya.

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Abstract

End-stage renal failure (ESRF) is associated with increased anesthetic risks such as perioperative hypotension and cardiovascular events, resulting in higher perioperative morbidity and mortality. The primary objective was to assess whether sedation with sevoflurane would be superior to TCI propofol in maintaining hemodynamic stability among ESRF patients undergoing brachiocephalic fistula repair. Methodology: We conducted a prospective study involving thirty-one end-stage renal failure (ESRF) patients scheduled for brachiocephalic fistula repair surgery, randomly assigned to either the SEVOFLURANE or TCI PROPOFOL group. Each participant received ultrasound-guided regional anaesthesia comprising supraclavicular brachial plexus block and pectoralis II block. Sevoflurane was delivered from general anaesthesia machine via nasal CPAP mask, while TCI Propofol was administered intravenously through a TCI pump. Demographics and medical details were retrieved from the hospital's electronic medical record system (EMR) and anaesthetic records. Subsequently, the data was transcribed into a structured data collection form and analyzed utilizing SPSS version 23. Statistical significance was established at p < 0.05. Results: The sevoflurane group demonstrated a more stable MAP trend without significant changes (p-value: 0.36) notably at 30 minutes compared to the propofol group which exhibited a drop of 20% in MAP (p-value: 0.02). In contrast, the variation in heart rate remained nonsignificant for both groups throughout. Within the sevoflurane group, there was a notable reduction in mean arterial pressure (MAP) (F (2.679) = 3.96, p = 0.03) and systolic blood pressure (F (2.20) = 7.57, p = 0.004. Heart rate within the sevoflurane group also exhibited a significant decrease (F (2.96) = 3.67, p = 0.03).Within the propofol group, significant variations were observed in mean arterial pressure (MAP) (F (1.91) = 4.51, p = 0.03) and systolic blood pressure (SBP) also exhibited noteworthy changes within the group (F (2.14) = 7.35, p = 0.005. However, unlike the sevoflurane group, heart rate (HR) in Group P did not demonstrate significant changes within the group (F (6) = 1.405, p = 0.24). The induction time was notably shorter (p-value: 0.007) in the propofol group, on average 5.0 minutes (IQR 2.5-7.5), compared to the sevoflurane group's 8.8 minutes (IQR 7.5-11.3). However, there was no significant difference in recovery time (p value 0.54) between the two groups, with propofol group averaging 5 minutes (IQR 2.5-5 minutes) and sevoflurane group also at same value. Conclusions: Sevoflurane may be a better sedation agent compared to TCI propofol for end stage renal failure patients by providing a more stable haemodynamic profile with minimal side effects. However, sevoflurane may take longer time to induce patient compare to TCI propofol.

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