title: Cerebrovascular reactivity to carbon dioxide is preserved during hypocapnia in children anesthetized with 1.0 MAC, but not with 1.5 MAC desflurane.
abstract: OBJECTIVE
  Maintenance of cerebrovascular reactivity to CO(2) (CCO(2)R) is important during neurosurgical anesthesia. This study was designed to determine the effect of different desflurane concentrations on CCO(2)R in children.
  
  
  METHODS
  Children undergoing urological surgery were enrolled. Anesthesia was induced with sevoflurane in air/oxygen. After intubation, sevoflurane was switched to desflurane. Analgesia was provided with an epidural neuraxial block. Mechanical ventilation was adjusted to an initial EtCO(2) of 30 mmHg. Exogenous CO(2) was used to achieve an EtCO(2) of 40 and 50 mmHg. Patients were randomized to the sequence of desflurane concentration (1.0 and 1.5 MAC) and the EtCO(2). Transcranial Doppler was used to measure middle cerebral artery blood flow velocity (Vmca). Five minutes were allowed to reach steady state after each change in EtCO(2) and 15 min after changing the desflurane concentration.
  
  
  RESULTS
  Sixteen patients were studied. The mean age and weight were 3.5 +/- 1.5 yr and 14.4 +/- 3.1 kg, respectively. Mean arterial pressure remained stable throughout the study, while at an EtCO(2) of 50 mmHg, heart rate decreased at both desflurane concentrations (P < 0.05). At 1.0 MAC, Vmca increased from 30 to 40 mmHg (P < 0.05), but not from 40 to 50 mmHg EtCO(2). At 1.5 MAC, Vmca increased between 30 and 50 mmHg (P < 0.05).
  
  
  CONCLUSIONS
  CCO(2)R is preserved during hypocapnia in children anesthetized with 1.0 MAC, but not with 1.5 MAC desflurane. The lack of further increase in Vmca at higher EtCO(2) concentrations implies that desflurane may cause significant cerebral vasodilatation in children. This may have important implications in children with reduced intracranial compliance.
authors.affiliation: Department of Anaesthesia, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Igor A
authors.initials: IA
authors.lastname: Luginbuehl
authors.forename: Cengiz
authors.initials: C
authors.lastname: Karsli
authors.forename: Bruno
authors.initials: B
authors.lastname: Bissonnette
mesh_terms: D000293:Adolescent; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation; D002245:Carbon Dioxide / Q000494:pharmacology*; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D000077335:Desflurane; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000503:physiopathology; D016857:Hypocapnia / Q000503:physiopathology*; D007530:Isoflurane / Q000031:analogs & derivatives*; D008297:Male; D017585:Ultrasonography, Doppler, Transcranial
chemical_list: D018685:Anesthetics, Inhalation; D002245:Carbon Dioxide; D000077335:Desflurane; D007530:Isoflurane