We. Hoffman et al., COMPARISON OF THE EFFECT OF ETOMIDATE AND DESFLURANE ON BRAIN-TISSUE GASES AND PH DURING PROLONGED MIDDLE CEREBRAL-ARTERY OCCLUSION, Anesthesiology, 88(5), 1998, pp. 1188-1194
Background: The authors compared the effects of etomidate and desflura
ne on brain tissue oxygen pressure (P-O2), carbon dioxide pressure (P-
CO2), and pH in patients who had middle cerebral artery occlusion for
>15 min. Methods: After a craniotomy, a probe that measures P-O2, P-CO
2, and pH was inserted into cortical tissue at risk for ischemia durin
g middle cerebral artery occlusion. A burst suppression pattern of the
electroencephalogram was induced with etomidate (n = 6) or 9% end-tid
al desflurane (n = 6) started before middle cerebral artery occlusion.
Mean blood pressure Was supported with phenylephrine to 90-95 mmHg. R
esults: During baseline conditions, tissue P-O2, P-CO2, and pH were si
milar between the two groups (P-O2 = 15 mmHg, P-CO2 = 60 mmHg, pH = 7.
1). During administration of etomidate before middle cerebral artery o
cclusion, tissue P-O2 decreased in five of six patients without a chan
ge in P-CO2 or pH. During administration of 9% desflurane, tissue P-O2
and pH increased before middle cerebral artery dipping. Middle cerebr
al artery occlusion for an average of 33 min with etomidate and 37 min
with desflurane produced a decrease in pH with etomidate (7.09 to 6.6
3, P < 0.05) but not With desflurane (7.12 to 7.15). Conclusion: These
results suggest that tissue hypoxia and acidosis are often observed d
uring etomidate treatment and middle cerebral artery occlusion. Treatm
ent with desflurane significantly increases tissue P-O2 alone and atte
nuates acidotic changes to prolonged middle cerebral artery occlusion.