Cerebral haemodynamic changes during propofol-remifentanil or sevoflurane anaesthesia: transcranial Doppler study under bispectral index monitoring |
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Authors: | Conti A Iacopino D G Fodale V Micalizzi S Penna O Santamaria L B |
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Institution: | Department of Neurosciences, Psychiatric and Anaesthesiological Sciences, University of Messina, School of Medicine, Policlinico Universitario "G. Martino", via C.Valeria 98125, Messina, Italy |
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Abstract: | Background. Sevoflurane or propofolremifentanil-basedanaesthetic regimens represent modern techniques for neurosurgicalanaesthesia. Nevertheless, there are potential differences relatedto their activity on the cerebrovascular system. The magnitudeof such difference is not completely known. Methods. In total 40 patients, treated for spinal or maxillo-facialdisorders, were randomly allocated to either i.v. propofolremifentanilor inhalational sevoflurane anaesthesia. Transcranial Dopplerwas used to assess changes in cerebral blood flow velocity,carbon dioxide reactivity, cerebral autoregulation and the bispectralindex to assess the depth of anaesthesia. Results. Time-averaged mean flow velocity (MFV) was significantlyreduced after induction of anaesthesia in both sevoflurane andpropofolremifentanil groups (P<0.001). At deeper levelsof anaesthesia, MFV increased in the sevoflurane group, suggestingan uncoupling flow/metabolism, whereas it was further reducedin the propofolremifentanil group (P<0.001). Indicesof cerebral autoregulation were reduced in patients with high-dosesevoflurane whereas autoregulation was preserved in patientsanaesthetized with propofolremifentanil (P<0.001).Higher CO2 concentrations impaired cerebral autoregulation inthe sevoflurane group but not in patients anaesthetized withpropofolremifentanil. Conclusions. Propofolremifentanil anaesthesia induceda dose-dependent low-flow state with preserved cerebral autoregulation,whereas sevoflurane at high doses provided a certain degreeof luxury perfusion. |
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Keywords: | anaesthetics inhalational sevoflurane anaesthetics i v propofol monitoring bispectral index monitoring transcranial Doppler ultrasonography |
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