title: Administration of sufentanil and nitrous oxide blunts cardiovascular effects of desflurane but does not prevent an increase in middle cerebral artery blood flow velocity.
abstract: Desflurane has been reported to cause tachycardia and hypertension during induction of anaesthesia. The aim of this study was to determine the effects of desflurane on cerebral blood flow (CBF) velocity using transcranial Doppler ultrasonography in a setting that closely resembled usual clinical practice. In two groups (n = 9 in each) ASA Grade I or II patients, anaesthesia was induced with etomidate and vecuronium intravenously (i.v.), sufentanil (0.3 microgram kg-1 i.v.) was added in the second group. Patients were ventilated by facemask for 2 min before desflurane was administered in steps of 0.5 MAC min-1 until 1.5 MAC was reached and maintained for 7 min. Haemodynamic variables and CBF velocity in the middle cerebral artery (MCA) were monitored throughout the study period. In group 1 heart rate increased to 108 +/- 2 b.p.m. (37% increase) whereas MAP increased to 114 +/- 6 mmHg after administration of desflurane (33% increase). CBF velocity increased to 86 +/- 7 cm s-1 (69% increase). In group 2 no significant changes in systemic haemodynamic responses were measured after desflurane administration; however, CBF velocity increased to 73 +/- 5 cm s-1 (59% increase). The results indicate that desflurane increases CBF velocity concurrently with induction of tachycardia and hypertension. Although sufentanil and N2O attenuate the systemic haemodynamic alterations caused by desflurane, the CBF velocity increases. These data suggest that the abrupt addition of desflurane may have adverse consequences in patients at risk for intracranial hypertension.
authors.affiliation: Department of Anaesthesiology, University Hospital Eppendorf, Hamburg, Germany.
authors.forename: P H
authors.initials: PH
authors.lastname: Tonner
authors.forename: J
authors.initials: J
authors.lastname: Scholz
authors.forename: T
authors.initials: T
authors.lastname: Krause
authors.forename: A
authors.initials: A
authors.lastname: Paris
authors.forename: G
authors.initials: G
authors.lastname: von Knobelsdorff
authors.forename: J
authors.initials: J
authors.lastname: Schulte an Esch
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D018681:Anesthetics, General; D018685:Anesthetics, Inhalation / Q000037:antagonists & inhibitors; D001794:Blood Pressure / Q000187:drug effects; D002536:Cerebral Arteries / Q000187:drug effects*; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D000077335:Desflurane; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives* / Q000037:antagonists & inhibitors; D008875:Middle Aged; D009609:Nitrous Oxide; D017409:Sufentanil; D017585:Ultrasonography, Doppler, Transcranial
chemical_list: D018681:Anesthetics, General; D018685:Anesthetics, Inhalation; D017409:Sufentanil; D000077335:Desflurane; D007530:Isoflurane; D009609:Nitrous Oxide