Korean J Anesthesiol.  2014 Nov;67(5):323-328. 10.4097/kjae.2014.67.5.323.

Cerebral blood flow change during volatile induction in large-dose sevoflurane versus intravenous propofol induction: transcranial Doppler study

• Jung HS
• Sung TY
• Kang H
• Kim JS
• Kim TY

• KMID: 2039528
• DOI: http://doi.org/10.4097/kjae.2014.67.5.323

Abstract

BACKGROUND
The impact of volatile induction using large-dose sevoflurane (VI-S) on cerebral blood flow has not been well investigated. The present study compared the changes in cerebral blood flow of middle cerebral artery using transcranial Doppler (TCD) during VI-S and conventional induction using propofol.
METHODS
Patients undergoing elective lumbar discectomy were randomly allocated to receive either sevoflurane (8%, Group VI-S, n = 11) or target-controlled infusion of propofol (effect site concentration, 3.0 microg/ml; Group P, n = 11) for induction of anesthesia. The following data were recorded before and at 1, 2, and 3 min after commencement of anesthetic induction (T0, T1, T2, and T3, respectively): mean velocity of the middle cerebral artery (V(MCA)) by TCD, mean blood pressure (MBP), heart rate, bispectral index score (BIS) and end-tidal CO2 (ETCO2). Changes in V(MCA) and MBP from their values at T0 (DeltaV(MCA) and DeltaMBP) at T1, T2, and T3 were also determined.
RESULTS
BISs at T1, T2 and T3 were significantly less than that at T0 in both groups (P < 0.05). DeltaVMCA in Group VI-S at T2 and T3 (18.1% and 12.4%, respectively) were significantly greater than those in Group P (-7.6% and -19.8%, P = 0.006 and P < 0.001, respectively), whereas ETCO2 and DeltaMBP showed no significant intergroup difference.
CONCLUSIONS
VI-S using large-dose sevoflurane increases cerebral blood flow resulting in luxury cerebral flow-metabolism mismatch, while conventional propofol induction maintains cerebral flow-metabolism coupling. This mismatch in VI-S may have to be considered in clinical application of VI-S.

Keyword

Cerebral blood flow; Sevoflurane; Volatile induction and maintenance of anesthesia

MeSH Terms

Anesthesia
Blood Pressure
Diskectomy
Heart Rate
Humans
Middle Cerebral Artery
Propofol*
Propofol