title: Carbon dioxide induced changes in cerebral blood flow and flow velocity: role of cerebrovascular resistance and effective cerebral perfusion pressure.
abstract: In addition to cerebrovascular resistance (CVR) zero flow pressure (ZFP), effective cerebral perfusion pressure (CPPe) and the resistance area product (RAP) are supplemental determinants of cerebral blood flow (CBF). Until now, the interrelationship of PaCO2-induced changes in CBF, CVR, CPPe, ZFP, and RAP is not fully understood. In a controlled crossover trial, we investigated 10 anesthetized patients aiming at PaCO2 levels of 30, 37, 43, and 50 mm Hg. Cerebral blood flow was measured with a modified Kety-Schmidt-technique. Zero flow pressure and RAP was estimated by linear regression analysis of pressure-flow velocity relationships of the middle cerebral artery. Effective cerebral perfusion pressure was calculated as the difference between mean arterial pressure and ZFP, CVR as the ratio CPPe/CBF. Statistical analysis was performed by one-way RM-ANOVA. When comparing hypocapnia with hypercapnia, CBF showed a significant exponential reduction by 55% and mean VMCA by 41%. Effective cerebral perfusion pressure linearly decreased by 17% while ZFP increased from 14 to 29 mm Hg. Cerebrovascular resistance increased by 96% and RAP by 39%; despite these concordant changes in mean CVR and Doppler-derived RAP correlation between these variables was weak (r=0.43). In conclusion, under general anesthesia hypocapnia-induced reduction in CBF is caused by both an increase in CVR and a decrease in CPPe, as a consequence of an increase in ZFP.
authors: Department of Anesthesiology, Erasmus MC, Rotterdam, The Netherlands.
authors: Frank
authors: F
authors: Grüne
authors: Center of Anesthesiology, Critical Care, Emergency Medicine and Pain Therapy, University-Hospital of Göttingen, Göttingen, Germany.
authors: Stephan
authors: S
authors: Kazmaier
authors: Department of Anesthesiology, Erasmus MC, Rotterdam, The Netherlands.
authors: Robert J
authors: RJ
authors: Stolker
authors: Department of Clinical Neurophysiology, Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands.
authors: Gerhard H
authors: GH
authors: Visser
authors: Deptarment of Anesthesiology, Critical Care, Emergency Medicine and Pain Therapy, Klinikum Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany.
authors: Andreas
authors: A
authors: Weyland
mesh_terms: D000768:Anesthesia, General; D001783:Blood Flow Velocity; D001794:Blood Pressure; D002245:Carbon Dioxide / Q000097:blood*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000097:blood / Q000503:physiopathology; D016857:Hypocapnia / Q000097:blood / Q000503:physiopathology; D008297:Male; D020768:Middle Cerebral Artery / Q000378:metabolism / Q000503:physiopathology; D014655:Vascular Resistance
chemical_list: D002245:Carbon Dioxide