title: Influence of aortic blood flow velocity on changes of middle cerebral artery blood flow velocity during isoflurane and sevoflurane anaesthesia.
abstract: OBJECTIVE
  We studied the influence of systemic (aortic) blood flow velocity on changes of cerebral blood flow velocity under isoflurane or sevoflurane anaesthesia.
  
  
  METHODS
  Forty patients (age: isoflurane 24-62 years; sevoflurane 24-61 years; ASA I-III) requiring general anaesthesia undergoing routine spinal surgery were randomly assigned to either group. Cerebral blood flow velocity was measured in the middle cerebral artery by transcranial Doppler sonography (depth: 50-60 mm). Systemic blood flow velocity was determined by transthoracic Doppler sonography at the aortic valve. Heart rate, arterial pressure, arterial oxygen saturation and body temperature were monitored. After standardized anaesthesia induction (propofol, remifentanil, vecuronium) sevoflurane or isoflurane were used as single agent anaesthetics. Cerebral blood flow velocity and systemic blood flow velocity were measured in the awake patient (baseline) and repeated 5 min after reaching a steady state of inspiratory and end-expiratory concentrations of 0.75, 1.00, and 1.25 mean alveolar concentrations of either anaesthetic. To calculate the influence of systemic blood flow velocity on cerebral blood flow velocity, we defined the cerebral-systemic blood flow velocity index (CSvI). CSvI of 100% indicates a 1:1 relationship of changes of cerebral blood flow velocity and systemic blood flow velocity.
  
  
  RESULTS
  Isoflurane and sevoflurane reduced both cerebral blood flow velocity and systemic blood flow velocity. The CSvI decreased significantly at all three concentrations vs. 100% (isoflurane/sevoflurane: 0.75 MAC: 85 +/- 25%/81 +/- 23%, 1.0 MAC: 79 +/- 19%/74 +/- 16%, 1.25 MAC: 71 +/- 16%/79 +/- 21%; [mean +/- SD] P = 0.0001).
  
  
  CONCLUSIONS
  The reduction of the CSvI vs. 100% indicates a direct reduction of cerebral blood flow velocity caused by isoflurane/sevoflurane, independently of systemic blood flow velocity.
authors.affiliation: Department of Anaesthesiology and General Intensive Care, University of Vienna, Austria. andrea.holzer@univie.ac.at
authors.forename: A
authors.initials: A
authors.lastname: Holzer
authors.forename: M
authors.initials: M
authors.lastname: Greher
authors.forename: H
authors.initials: H
authors.lastname: Hetz
authors.forename: H
authors.initials: H
authors.lastname: Standhardt
authors.forename: A
authors.initials: A
authors.lastname: Donner
authors.forename: H
authors.initials: H
authors.lastname: Heinzl
authors.forename: M
authors.initials: M
authors.lastname: Zimpfer
authors.forename: U M
authors.initials: UM
authors.lastname: Illievich
mesh_terms: D000328:Adult; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation; D001011:Aorta / Q000502:physiology; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007530:Isoflurane; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000187:drug effects*; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D007530:Isoflurane