Effects of intravenous anesthesia with propofol on regional cortical blood flow and intracranial pressure in surgery for moyamoya disease.
BACKGROUND
The aim of this study was to compare the effects of inhalation anesthesia with sevoflurane and intravenous anesthesia with propofol on ICP and rCoBF during revascularization surgery for patients with MMD.


METHODS
Between 1999 and 2004, a total of 90 revascularization surgeries were performed on 58 patients. Among them, in 20 consecutive operations on 14 patients, continuous monitoring of ICP was performed with an ICP monitoring probe. Subsequently, in 14 consecutive operations on 9 patients (CoBF group), intraoperative monitoring of rCoBF was carried out with a laser Doppler flowmeter probe. The monitoring of ICP and rCoBF was performed for more than 20 minutes after the administration of anesthetic was changed from 1.5% to 2.5% sevoflurane to 6 mg/kg per hour of propofol. In all cases, the Paco(2) of these patients was strictly maintained between 38 and 40 mm Hg throughout the operations.


RESULTS
In both the ICP and the CoBF groups, the values of physiologic parameters obtained under inhalation anesthesia did not differ statistically from those obtained under intravenous anesthesia. The value for ICP under anesthesia with propofol was significantly lower than that under anesthesia with sevoflurane (P < .0001). The value for rCoBF in the frontal lobe under anesthesia with propofol was significantly higher than that under anesthesia with sevoflurane.


CONCLUSIONS
Intravenous anesthesia with propofol has potential to provide brain protection and preservation of rCBF in the frontal lobes in surgery for MMD. Whether choice of anesthetic agents might be important in surgery for MMD should be investigated further.
Kikuta
Ken-Ichiro
K
Department of Neurosurgery, Kyoto University Graduate School of Medicine, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan. kikuta@kuhp.kyoto-u.ac.jp
Takagi
Yasushi
Y
Nozaki
Kazuhiko
K
Yamada
Keisuke
K
Miyamoto
Susumu
S
Kataoka
Hiroharu
H
Arai
Toshiyuki
T
Hashimoto
Nobuo
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D001784:Blood Gas Analysis; D001794:Blood Pressure / Q000187:drug effects; D002540:Cerebral Cortex / Q000098:blood supply*; D002548:Cerebral Revascularization; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007427:Intracranial Pressure / Q000187:drug effects*; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009072:Moyamoya Disease / Q000503:physiopathology / Q000601:surgery*; D015742:Propofol; D000077149:Sevoflurane
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D015742:Propofol