title: Effects of sevoflurane with and without nitrous oxide on human cerebral circulation. Transcranial Doppler study.
abstract: BACKGROUND
  This study was designed to evaluate the effects of sevoflurane with and without nitrous oxide on human middle cerebral artery (MCA) flow velocity, cerebrovascular carbon dioxide reactivity, and autoregulation compared with the awake state using transcranial Doppler ultrasonography.
  
  
  METHODS
  In 14 patients, the time-mean middle cerebral artery flow velocity (Vmca) was measured when the end-tidal carbon dioxide level was approximately 30, 40, and 50 mmHg under the following conditions: (1) awake; (2) with 2% (1.2 MAC) sevoflurane; and (3) with 1.2 MAC sevoflurane-60% nitrous oxide. In six other patients, the cerebrovascular autoregulation during anesthesia was determined using intravenous phenylephrine to increase blood pressure.
  
  
  RESULTS
  Sevoflurane (1.2 MAC) significantly decreased Vmca compared with the awake value at each level of end-tidal carbon dioxide, whereas 1.2 MAC sevoflurane-60% nitrous oxide did not exert significant influence. The Vmca in normocapnic patients decreased from 69 cm/s to 55 cm/s with 1.2 MAC sevoflurane and then increased to 70 cm/s when nitrous oxide was added. Sevoflurane (1.2 MAC) with and without 60% nitrous oxide had a negligible effect on cerebrovascular carbon dioxide reactivity. A phenylephrine-induced increase of mean arterial pressure did not influence Vmca during anesthesia.
  
  
  CONCLUSIONS
  Sevoflurane (1.2 MAC) reduced Vmca compared with the awake condition, whereas the addition of nitrous oxide caused Vmca to increase toward the values obtained in the awake condition. The cerebrovascular carbon dioxide reactivity and autoregulation were well maintained during 1.2 MAC sevoflurane with and without 60% nitrous oxide.
authors.affiliation: Department of Anesthesiology, Nagasaki University School of Medicine, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Cho
authors.forename: T
authors.initials: T
authors.lastname: Fujigaki
authors.forename: Y
authors.initials: Y
authors.lastname: Uchiyama
authors.forename: M
authors.initials: M
authors.lastname: Fukusaki
authors.forename: O
authors.initials: O
authors.lastname: Shibata
authors.forename: K
authors.initials: K
authors.lastname: Sumikawa
mesh_terms: D000328:Adult; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D001783:Blood Flow Velocity / Q000187:drug effects; D002245:Carbon Dioxide; D002560:Cerebrovascular Circulation / Q000187:drug effects* / Q000502:physiology; D004987:Ethers / Q000008:administration & dosage*; D005260:Female; D006706:Homeostasis / Q000187:drug effects; D006801:Humans; D008297:Male; D008738:Methyl Ethers; D009609:Nitrous Oxide / Q000008:administration & dosage*; D000077149:Sevoflurane; D017585:Ultrasonography, Doppler, Transcranial; D014851:Wakefulness
chemical_list: D018685:Anesthetics, Inhalation; D004987:Ethers; D008738:Methyl Ethers; D002245:Carbon Dioxide; D000077149:Sevoflurane; D009609:Nitrous Oxide