Effects of theophylline on human cerebral blood flow velocity during halothane and isoflurane anaesthesia

Abstract

The acute influence of therapeutic doses of theophylline on cerebral blood flow velocities during general anaesthesia induced either by halothane or isoflurane has not been elucidated previously. The aim of this study, was therefore to investigate these effects during steady state anaesthetic conditions in anaesthetized patients using transcranial Doppler sonography. Thirty-four Patients were investigated. Anaesthesia was maintained either with 1 MAC (minimum alveolar concentration) halothane (n=16) or 1 MAC isoflurane (n=18); FiO₂: 40%; end-expiratory pCO₂: normocapnia. Theophylline administration was performed before surgery by infusing 6 mg kg⁻¹ over a period of 7.5 min. Measurements were recorded prior to theophylline administration, and immediately after 2 mg kg⁻¹ (2.5 min), 4 mg kg⁻¹ (5 min) and 6 mg kg⁻¹ (7.5 min), as well as 5, 10, 15, 20, 30 and 45 min after theophylline administration. Recorded variables included blood pressure, heart rate, arterial oxygen saturation, end-expiratory pCO₂, body temperatures, middle cerebral artery blood flow velocity and pulsatility index. Theophylline administration was well tolerated by all study subjects. Heart rate, blood pressure, body temperatures, arterial oxygen saturation and end-expiratory pCO₂ remained constant during the whole examination period. Following theophylline, mean blood flow velocity decreased by 25% in the halothane and by 30% in the isoflurane group (P< 0.05). By the end of the examination period, mean blood flow velocity had not yet recovered to the initial values whereby in both groups the mean blood flow velocity was 26% below the initial values. In the isoflurane group, the pulsatility index increased by about 20% (P< 0.05) and remained high until the end of the examination. In the halothane group, however, there were no changes in the pulsatility index. Our results show a remarkable, significant and simultaneous decrease in blood flow velocity in the middle cerebral artery associated with theophylline administration during halothane and isoflurane anaesthesia in man.