title: Cerebral autoregulation and CO2 reactivity in anterior and posterior cerebral circulation during sevoflurane anesthesia.
abstract: The purpose of the study was to compare cerebral autoregulation (CA) and CO2 reactivity (CO2R) between the anterior and posterior circulation under sevoflurane anesthesia. We studied 9 adult ASA physical status I patients (22-47 yr) scheduled for elective orthopedic surgery. Blood flow velocity in the middle cerebral artery (Vmca) and in the basilar artery (Vba) were measured using transcranial Doppler ultrasonography. For CA testing, arterial blood pressure was increased using phenylephrine infusion. CA was quantified with the autoregulatory index (ARI). CO2R was investigated at PaCO2 of 30 +/- 2.8 mm Hg, 39.4 +/- 2.6 mm Hg, and 48.7 +/- 2.8 mm Hg. Linear regression analysis was used for CO2R. We found ARI was preserved in both arteries: ARImca (middle cerebral artery) = 0.72 +/- 0.2; ARIba (basilar artery) = 0.66 +/- 0.2; P = 0.5. With regard to CO2R, Vmca increased with slope of 1.7 cm/s/mm Hg PaCO2, Vba increased with slope of 1.5 cm/s/mm Hg PaCO2; P = 0.83. Absolute Vmca was higher compared with Vba; P < 0.05. We conclude that in healthy individuals under 0.5 MAC of sevoflurane and small-dose remifentanil: 1) mean flow velocities of BA are less than those of MCA; 2) autoregulation and CO2R are preserved in the basilar artery and are similar to those of MCA.
authors.affiliation: Department of Anesthesiology, University of Washington, Seattle, Washington, USA. i_rozet@hotmail.com
authors.forename: Irene
authors.initials: I
authors.lastname: Rozet
authors.forename: Monica S
authors.initials: MS
authors.lastname: Vavilala
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Lindley
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Visco
authors.forename: Miriam
authors.initials: M
authors.lastname: Treggiari
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Lam
mesh_terms: D000328:Adult; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D001488:Basilar Artery; D001783:Blood Flow Velocity / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D002245:Carbon Dioxide / Q000502:physiology*; D002560:Cerebrovascular Circulation / Q000187:drug effects; D005260:Female; D006706:Homeostasis / Q000187:drug effects*; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000494:pharmacology*; D008875:Middle Aged; D020768:Middle Cerebral Artery; D010656:Phenylephrine / Q000494:pharmacology; D000077149:Sevoflurane; D017585:Ultrasonography, Doppler, Transcranial
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D002245:Carbon Dioxide; D010656:Phenylephrine; D000077149:Sevoflurane