Monitoring of cerebral blood flow autoregulation in adults undergoing sevoflurane anesthesia: a prospective cohort study of two age groups.
Autoregulation of blood flow is a key feature of the human cerebral vascular system to assure adequate oxygenation and metabolism of the brain under changing physiological conditions. The impact of advanced age and anesthesia on cerebral autoregulation remains unclear. The primary objective of this study was to determine the effect of sevoflurane anesthesia on cerebral autoregulation in two different age groups. This is a follow-up analysis of data acquired in a prospective observational cohort study. One hundred thirty-three patients aged 18-40 and ≥65 years scheduled for major noncardiac surgery under general anesthesia were included. Cerebral autoregulation indices, limits, and ranges were compared in young and elderly patient groups. Forty-nine patients (37 %) aged 18-40 years and 84 patients (63 %) aged ≥65 years were included in the study. Age-adjusted minimum alveolar concentrations of sevoflurane were 0.89 ± 0.07 in young and 0.99 ± 0.14 in older subjects (P < 0.001). Effective autoregulation was found in a blood pressure range of 13.8 ± 9.8 mmHg in young and 10.2 ± 8.6 mmHg in older patients (P = 0.079). The lower limit of autoregulation was 66 ± 12 mmHg and 73 ± 14 mmHg in young and older patients, respectively (P = 0.075). The association between sevoflurane concentrations and autoregulatory capacity was similar in both age groups. Our data suggests that the autoregulatory plateau is shortened in both young and older patients under sevoflurane anesthesia with approximately 1 MAC. Lower and upper limits of cerebral blood flow autoregulation, as well as the autoregulatory range, are not influenced by the age of anesthetized patients. Trial registration ClinicalTrials.gov (NCT00512200).
Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, University of Basel, Spitalstrasse 21, 4031, Basel, Switzerland. nicolai.goettel@usb.ch.|Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland. nicolai.goettel@usb.ch.
Nicolai
http://orcid.org/0000-0003-0191-9775
N
Goettel
Department of Anesthesiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
Camille
C
Patet
Department of Anesthesiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
Ariane
A
Rossi
Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, University of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.|Department of Anesthesia and Intensive Care Medicine, Kantonsspital Graubünden, Chur, Switzerland.
Christoph S
CS
Burkhart
Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
Marek
M
Czosnyka
Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, University of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
Stephan P
SP
Strebel
Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, University of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.|Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
Luzius A
LA
Steiner
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018685:Anesthetics, Inhalation / Q000008:administration & dosage* / Q000493:pharmacokinetics; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002560:Cerebrovascular Circulation / Q000187:drug effects / Q000502:physiology*; D015331:Cohort Studies; D005260:Female; D006706:Homeostasis / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage* / Q000493:pharmacokinetics; D011446:Prospective Studies; D000077149:Sevoflurane; D017585:Ultrasonography, Doppler, Transcranial; D055815:Young Adult
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane
Age; Cerebral blood flow autoregulation; Inhalational anesthesia; Sevoflurane; Transcranial doppler ultrasonography