A. Holzer et al., Influence of aortic blood flow velocity on changes of middle cerebral artery blood flow velocity during isoflurane and sevoflurane anaesthesia, EUR J ANAES, 18(4), 2001, pp. 238-244
Background and objective We studied the influence of systemic (aortic) bloo
d flow velocity on changes of cerebral blood flow velocity under isoflurane
or sevoflurane anaesthesia.
Methods Forty patients (age: isoflurane 24-62 years; sevoflurane 24-61 year
s; ASA I-III) requiring general anaesthesia undergoing routine spinal surge
ry were randomly assigned to either group. Cerebral blood flow velocity was
measured in the middle cerebral artery by transcranial Doppler sonography
(depth: 50-60 mm). Systemic blood flow velocity was determined by transthor
acic Doppler sonography at the aortic valve. Heart rate, arterial pressure,
arterial oxygen saturation and body temperature were monitored. After stan
dardized anaesthesia induction (propofol, remifentanil, vecuronium) sevoflu
rane or isoflurane were used as single agent anaesthetics. Cerebral blood f
low velocity and systemic blood flow velocity were measured in the awake pa
tient (baseline) and repeated 5 min after reaching a steady state of inspir
atory and end-expiratory concentrations of 0.75, 1.00, and 1.25 mean alveol
ar concentrations of either anaesthetic. To calculate the influence of syst
emic blood flow velocity on cerebral blood flow velocity, we defined the ce
rebral-systemic blood flow velocity index (CSvl). CSvl of 100% indicates a
1:1 relationship of changes of cerebral blood flow velocity and systemic bl
ood flow velocity.
Results Isoflurane and sevoflurane reduced both cerebral blood flow velocit
y and systemic blood flow velocity. The CSvl decreased significantly at all
three concentrations vs, 100% (jsoflurane/sevoflurane: 0.75 MAC: 85 +/- 25
%/81 +/- 23%, 1.0 MAC: 79 +/- 19%/74 +/- 16%, 1.25 MAC: 71 +/- 16%/79 +/- 2
1%; [mean +/-SD] P = 0.0001).
Conclusions The reduction of the CSvl vs. 100% indicates a direct reduction
of cerebral blood flow velocity caused by isoflurane/sevoflurane, independ
ently of systemic blood flow velocity.