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RESEARCH PRODUCT
Cerebral haemodynamic changes during propofol-remifentanil or sevoflurane anaesthesia: transcranial Doppler study under bispectral index monitoring
Letterio B. SantamariaAlfredo ContiOlivia PennaVincenzo FodaleDomenico Gerardo IacopinoS. Micalizzisubject
MaleUltrasonography Doppler TranscranialHemodynamicsBlood PressurePiperidinesHeart RateMedicineHomeostasisProspective StudiesPropofolUltrasonographyIntraoperativeAdult Anesthetics; Combined; pharmacology Anesthetics; Inhalation; Intravenous; pharmacology Blood Flow Velocity; drug effects Blood Pressure; drug effects Carbon Dioxide; physiology Cerebrovascular Circulation; drug effects Electroencephalography Female Heart Rate; drug effects Homeostasis; drug effects Humans Male Methyl Ethers; pharmacology Middle Aged Monitoring; Intraoperative; methods Piperidines; pharmacology Propofol; pharmacology Prospective Studies Ultrasonography; Doppler; TranscranialCombineddrug effectDopplerElectroencephalographyMiddle AgedAnesthetics CombinedCerebral blood flowInhalationBispectral indexAnesthesiaCerebrovascular CirculationAnesthetics InhalationmethodFemaleIntravenousPropofolAnesthetics IntravenousBlood Flow Velocitymedicine.drugHumanMethyl EthersAdultMonitoringRemifentanilIntravenouTranscranialCerebral autoregulationtranscranial DopplerSevofluranemethodsRemifentanilSevofluranePiperidineMonitoring IntraoperativeHomeostasiHumansAnestheticsbusiness.industryAnestheticCarbon DioxideTranscranial DopplerProspective StudieAnesthesiology and Pain MedicineMethyl Etherdrug effectsphysiologypharmacologybusinessdescription
Background. Sevoflurane or propofol–remifentanil-based anaesthetic regimens represent modern techniques for neurosurgical anaesthesia. Nevertheless, there are potential differences related to their activity on the cerebrovascular system. The magnitude of such difference is not completely known. Methods. In total 40 patients, treated for spinal or maxillo-facial disorders, were randomly allocated to either i.v. propofol–remifentanil or inhalational sevoflurane anaesthesia. Transcranial Doppler was used to assess changes in cerebral blood flow velocity, carbon dioxide reactivity, cerebral autoregulation and the bispectral index to assess the depth of anaesthesia. Results. Time-averaged mean flow velocity (MFV) was significantly reduced after induction of anaesthesia in both sevoflurane and propofol–remifentanil groups (P<0.001). At deeper levels of anaesthesia, MFV increased in the sevoflurane group, suggesting an uncoupling flow/metabolism, whereas it was further reduced in the propofol–remifentanil group (P<0.001). Indices of cerebral autoregulation were reduced in patients with high-dose sevoflurane whereas autoregulation was preserved in patients anaesthetized with propofol–remifentanil (P<0.001). Higher CO2 concentrations impaired cerebral autoregulation in the sevoflurane group but not in patients anaesthetized with propofol–remifentanil. Conclusions. Propofol–remifentanil anaesthesia induced a dose-dependent low-flow state with preserved cerebral autoregulation, whereas sevoflurane at high doses provided a certain degree of luxury perfusion.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2006-01-01 |