Changes in hemodynamics during isoflurane and propofol anesthesia: a comparison study.
OBJECTIVE
Volatile anesthetics are thought to impair cerebral autoregulation more than i.v. anesthetics. However, few comparative studies have been carried out in humans. The aim of our study was to evaluate the differences in cerebral hemodynamic changes after introduction of isoflurane (a volatile anesthetic) and propofol (an i.v. anesthetic).


METHODS
Eighteen consecutive patients submitted to laparoscopic cholecystectomy were selected. After the induction, anesthesia was maintained by isoflurane (one minimum alveolar anesthetic concentration) during the first part of the surgical operation, and then by propofol (5 mg/kg/hour i.v.). Ventilation was adjusted to maintain a constant end-tidal CO(2). Middle artery flow velocity was assessed by means of transcranial Doppler ultrasonography. Arterial blood pressure, heart rate (HR), capnometry, pulse oxymetry, inspired fraction of O(2), and body temperature, were monitored.


RESULTS
Cerebral artery velocity, HR, and mean arterial pressure all significantly increased from baseline after the introduction of isoflurane (p<0.05); the HR and mean arterial blood pressure showed no significant difference between the isoflurane and propofol phases. Isoflurane anesthesia induced a significant increase in cerebral blood velocity. Propofol introduction led to a significant decrease in cerebral artery velocity (p<0.05).


CONCLUSIONS
Propofol but not isoflurane decreased cerebral blood velocity thus restoring cerebral autoregulation and the coupling between cerebral blood flow and cerebral metabolism.
De Cosmo
G
G
Institute of Anesthesiology and Reanimation, Catholic University of Rome, Italy Largo A. Gemelli, 00168 Roma, Italy.
Cancelli
I
I
Adduci
A
A
Merlino
G
G
Aceto
P
P
Valente
M
M
D000328:Adult; D000368:Aged; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D001783:Blood Flow Velocity / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D002560:Cerebrovascular Circulation / Q000187:drug effects; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D005069:Evaluation Studies as Topic; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007530:Isoflurane / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000494:pharmacology*; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D007530:Isoflurane; D015742:Propofol