The effects of sevoflurane on cerebral hemodynamics during propofol anesthesia.
We investigated the cerebral hemodynamic effects of 0.5 and 1.5 minimum alveolar anesthetic concentration (MAC) sevoflurane during propofol anesthesia in 10 patients undergoing supratentorial tumor resection. All patients received a standardized anesthetic, and their lungs were ventilated with a mixture of air and oxygen to produce mild hypocapnia. Anesthesia was then maintained with a propofol infusion. Muscle relaxation was obtained by infusion of atracurium. A transcranial Doppler probe was used to measure red cell flow velocity in the right middle cerebral artery (Vmca). A right-sided jugular bulb catheter was inserted for sampling of jugular bulb blood. After a 30-min period of stabilization and before the start of surgery, baseline arterial and jugular bulb blood samples were drawn to define the arterial-venous oxygen content difference (AVDO2). Mean arterial pressure and Vmca were recorded. Sevoflurane (0.5 and 1.5 MAC) in oxygen/air was then administered, and all measurements were repeated. Administration of sevoflurane at 0.5 MAC did not change Vmca or AVDO2. Sevoflurane (1.5 MAC) did not change Vmca. There was an approximately 25% reduction in AVDO2 (P < 0.05). This suggests that during propofol anesthesia, although 1.5 MAC sevoflurane does not increase red blood cell velocity, there is a relative increase in flow with respect to metabolism. Administration of large-dose sevoflurane may be associated with a degree of luxury perfusion.


CONCLUSIONS
We investigated the cerebral hemodynamic effects of sevoflurane in patients undergoing neurosurgery. Small-dose sevoflurane (1%) did not change brain blood flow or oxygen consumption. Large-dose sevoflurane (3%) did not change flow velocity but reduced brain oxygen consumption by 25%. Sevoflurane may provide a degree of luxury perfusion.
Heath
K J
KJ
Department of Anesthesia, Addenbrooke's Hospital, Cambridge, United Kingdom.
Gupta
S
S
Matta
B F
BF
D000328:Adult; D000368:Aged; D000758:Anesthesia; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D018686:Anesthetics, Intravenous; D001783:Blood Flow Velocity / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D002245:Carbon Dioxide / Q000097:blood; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D004987:Ethers / Q000494:pharmacology*; D006801:Humans; D008738:Methyl Ethers; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D015742:Propofol; D000077149:Sevoflurane; D015173:Supratentorial Neoplasms / Q000601:surgery
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D004987:Ethers; D008738:Methyl Ethers; D002245:Carbon Dioxide; D000077149:Sevoflurane; D010100:Oxygen; D015742:Propofol