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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
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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

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