Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-10T11:53:38.635Z Has data issue: false hasContentIssue false
  • English
  • Français

Effect of sevoflurane on cerebral blood flow and cerebrovascular resistance at surgical level of anaesthesia: a transcranial Doppler study

Published online by Cambridge University Press:  14 September 2006

C. Molnár ,
G. Settakis ,
P. Sárkány ,
S. Kálmán ,
S. Szabó  and
B. Fülesdi
C. Molnár
Affiliation:
University of Debrecen, Department of Anesthesiology and Intensive Care, Debrecen, Hungary
G. Settakis
Affiliation:
University of Debrecen, Department of Anesthesiology and Intensive Care, Debrecen, Hungary
P. Sárkány
Affiliation:
University of Debrecen, Department of Anesthesiology and Intensive Care, Debrecen, Hungary
S. Kálmán
Affiliation:
University of Debrecen, Department of Anesthesiology and Intensive Care, Debrecen, Hungary
S. Szabó
Affiliation:
University of Debrecen, Department of Neurosurgery, Health and Medical Science Centre, Debrecen, Hungary
B. Fülesdi
Affiliation:
University of Debrecen, Department of Anesthesiology and Intensive Care, Debrecen, Hungary
Get access

Abstract

Summary

Background and objective: It is widely accepted that sevoflurane affects cerebral circulation, but there are uncertainities regarding the magnitude of its effect. The aim of the present work was to assess the effect of sevoflurane on the cerebral circulation at surgical levels of anaesthesia. Methods: Twenty patients undergoing elective lumbar discectomies were investigated. Anaesthesia was induced with propofol and maintained with sevoflurane. The level of surgical anaesthesia was determined by bispectral index, the target level was 45–55. Transcranial Doppler (TCD) measurement was performed before induction and after reaching the surgical level of anaesthesia. Besides routine parameters (middle cerebral artery mean blood flow velocity (MCAV) and pulsatility index (PI)) derived parameters (estimated cerebral perfusion pressure (eCPP), cerebral blood flow index (CBFI) and resistance area product (RAP)) were calculated by taking changes of mean arterial pressure also into account. Results: MCAV decreased from 54.1 ± 13.3 to 43.7 ± 18.5 cm s−1, P < 0.01 and PI increased from 0.79 ± 0.2 to 0.92 ± 0.2, P < 0.01 after reaching the surgical level of anaesthesia. As a result eCPP decreased by 18.2%, CBFI by 25.5% and RAP increased by 15% respectively. Conclusions: Our data indicate a vasodilatory effect of sevoflurane at surgical level of anaesthesia on large cerebral vessels or a vasoconstriction of the resistance arterioles likely caused by decreased brain metabolism.

Keywords

CEREBROVASCULAR CIRCULATIONULTRASONOGRAPHY DOPPLER TRANSCRANIALSEVOFLURANEANAESTHESIA GENERAL
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 2 , February 2007 , pp. 179 - 184
Copyright
2007 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Delgado-Herrera L, Ostroff RD, Rogers SA. Sevoflurance: approaching the ideal inhalational anesthetic.A pharmacologic, pharmacoeconomic, and clinical review. CNS Drug Rev 2001; 7: 48–120.Google Scholar
Lorenz IH, Kolbitsch C, Hormann Cet al. Subanesthetic concentration of sevoflurane increases regional cerebral blood flow more, but regional cerebral blood volume less, than subanesthetic concentration of isoflurane in human volunteers. J Neurosurg Anesthesiol 2001; 13: 288–295.Google Scholar
Petersen KD, Landsfeldt U, Cold GEet al. Intracranial pressure and cerebral hemodynamic in patients with cerebral tumors: a randomized prospective study of patients subjected to craniotomy in propofol-fentanyl, isoflurane-fentanyl, or sevoflurane-fentanyl anesthesia. Anesthesiology 2003; 98: 329–336.Google Scholar
Matta BF, Heath KJ, Tipping K, Summors AC. Direct cerebral vasodilatory effects of sevoflurane and isoflurane. Anesthesiology 1999; 91: 677–680.Google Scholar
Fairgrieve R, Rowney DA, Karsli C, Bissonnette B. The effect of sevoflurane on cerebral blood flow velocity in children. Acta Anaesthesiol Scand 2003; 47: 1226–1230.Google Scholar
Schlunzen L, Vafaee MS, Cold GE, Rasmussen M, Nielsen JF, Gjedde A. Effects of subanaesthetic and anaesthetic doses of sevoflurane on regional cerebral blood flow in healthy volunteers. A positron emission tomographic study. Acta Anaesthesiol Scand 2004; 48: 1268–1276.Google Scholar
Bundgaard H, von Oettingen G, Larsen KMet al. Effects of sevoflurane on intracranial pressure, cerebral blood flow and cerebral metabolism. A dose-response study in patients subjected to craniotomy for cerebral tumours. Acta Anaesthesiol Scand 1998; 42: 621–627.Google Scholar
Kolbitsch C, Lorenz IH, Hormann Cet al. A subanesthetic concentration of sevoflurane increases regional cerebral blood flow and regional cerebral blood volume and decreases regional mean transit time and regional cerebrovascular resistance in volunteers. Anesth Analg 2000; 91: 156–162.Google Scholar
Oshima T, Karasawa F, Okazaki Y, Wada H, Satoh T. Effects of sevoflurane on cerebral blood flow and cerebral metabolic rate of oxygen in human beings: a comparison with isoflurane. Eur J Anaesthesiol 2003; 20: 543–547.Google Scholar
Schwender D, End H, Daunderer M, Fiedermutz M, Peter K. Sevoflurane and the nervous system. Anaesthesist 1998; 47(S1): S37–S42.Google Scholar
Mielck F, Stephan H, Weyland A, Sonntag H. Effects of one minimum alveolar anesthetic concentration sevoflurane on cerebral metabolism, blood flow, and CO2 reactivity in cardiac patients. Anesth Analg 1999; 89: 364–369.Google Scholar
Kaisti KK, Langsjo JW, Aalto Set al. Effects of sevoflurane, propofol, and adjunct nitrous oxide on regional cerebral blood flow, oxygen consumption, and blood volume in humans. Anesthesiology 2003; 99: 603–613.Google Scholar
Holzer A, Greher M, Hetz Het al. Influence of aortic blood flow velocity on changes of middle cerebral artery blood flow velocity during isoflurane and sevoflurane anaesthesia. Eur J Anaesthesiol 2001; 18: 238–244.Google Scholar
Holzer A, Winter W, Greher Met al. A comparison of propofol and sevoflurane anaesthesia: effects on aortic blood flow velocity and middle cerebral artery blood flow velocity. Anaesthesia 2003; 58: 217–222.Google Scholar
Kaisti KK, Metsahonkala L, Teras Met al. Effects of surgical levels of propofol and sevoflurane anesthesia on cerebral blood flow in healthy subjects studied with positron emission tomography. Anesthesiology 2002; 96: 1358–1370.Google Scholar
Iida H, Ohata H, Iida M, Watanabe Y, Dohi S. Isoflurane and sevoflurane induce vasodilation of cerebral vessels via ATP-sensitive K+ channel activation. Anesthesiology 1998; 89: 954–960.Google Scholar
Holmstrom A, Akeson J. Sevoflurane induces less cerebral vasodilation than isoflurane at the same A-line autoregressive index level. Acta Anaesthesiol Scand 2005; 49: 16–22.Google Scholar
Aaslid R, Lundar T, Lindegaard KF, Nornes H. Estimation of cerebral perfusion pressure from arterial blood pressure and transcranial Doppler recordings. In: Miller T, Rowan JO, eds. Intracranial Pressure.Berlin-Heidelberg: Springer, 1986: 226–229.
Giannina G, Belfort MA, Cruz AL, Herd JA. Changes in cerebral perfusion pressure in puerperal women with preeclampsia. Obstet Gynecol 1998; 92: 1016–1019.Google Scholar
Zatik J, Major T, Aranyosi J, Molnar C, Limburg M, Fülesdi B. Assessment of cerebral hemodynamics during roll over test in healthy pregnant women and those with pre-eclampsia. BJOG 2001; 108: 353–358.Google Scholar
Steiner LA, Johnston AJ, Czosnyka Met al. Direct comparison of cerebrovascular effects of norepinephrine and dopamine in head-injured patients. Crit Care Med 2004; 32: 1049–1054.Google Scholar
Steiner LA, Coles JP, Johnston AJet al. Assessment of cerebrovascular autoregulation in head-injured patients: a validation study. Stroke 2003; 34: 2404–2409.Google Scholar
Rozet I, Vavilala MS, Lindley AM, Visco E, Treggiari M, Lam AM. Cerebral autoregulation and CO2 reactivity in anterior and posterior circulation during sevoflurane anesthesia. Anesth Analg 2006; 102: 560–564.Google Scholar
Serrador JM, Picot PA, Rutt BK, Shoemaker JK, Bondar RL. MRI measures of middle cerebral artery diameter in conscious humans during simulated orthostasis. Stroke 2000; 31: 1672–1678.Google Scholar