Cerebral Pressure Autoregulation and Carbon Dioxide Reactivity During Propofol-Induced EEG Suppression

Matta, Basil F.; Lam, Arthur M.; Strebel, S.; Mayberg, Teresa S.

doi:10.1097/00132586-199512000-00024

Cited by 25 publications

(40 citation statements)

References 26 publications

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“…Tests for normal distribution of data were performed with the D'Agostino-Pearson omnibus K2 method. Effective cerebral perfusion pressure (CPPe) 5,7 CPPe = MAP-ZFP mm Hg Cerebral vascular resistance (CVR) 5 CVR = CPPe/CBF mm Hg/mL/100 g/min Resistance area product (RAP) 2,10 RAP = inverse slope of the relationship of pressure/flow velocity MCA mm Hg × s/cm Relative carbon dioxide reactivity (CO 2 -R) 18 CO 2 Both CPPe and CVR determine CO 2 reactivity of CBF F Grüne et al…”

Section: Discussionmentioning

confidence: 99%

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Carbon Dioxide Induced Changes in Cerebral Blood Flow and Flow Velocity: Role of Cerebrovascular Resistance and Effective Cerebral Perfusion Pressure

Grüne

Kazmaier

Stolker

et al. 2015

J Cereb Blood Flow Metab

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In addition to cerebrovascular resistance (CVR) zero flow pressure (ZFP), effective cerebral perfusion pressure (CPPe) and the resistance area product (RAP) are supplemental determinants of cerebral blood flow (CBF). Until now, the interrelationship of PaCO 2 -induced changes in CBF, CVR, CPPe, ZFP, and RAP is not fully understood. In a controlled crossover trial, we investigated 10 anesthetized patients aiming at PaCO 2 levels of 30, 37, 43, and 50 mm Hg. Cerebral blood flow was measured with a modified Kety-Schmidt-technique. Zero flow pressure and RAP was estimated by linear regression analysis of pressure-flow velocity relationships of the middle cerebral artery. Effective cerebral perfusion pressure was calculated as the difference between mean arterial pressure and ZFP, CVR as the ratio CPPe/CBF. Statistical analysis was performed by one-way RM-ANOVA. When comparing hypocapnia with hypercapnia, CBF showed a significant exponential reduction by 55% and mean V MCA by 41%. Effective cerebral perfusion pressure linearly decreased by 17% while ZFP increased from 14 to 29 mm Hg. Cerebrovascular resistance increased by 96% and RAP by 39%; despite these concordant changes in mean CVR and Doppler-derived RAP correlation between these variables was weak (r = 0.43). In conclusion, under general anesthesia hypocapnia-induced reduction in CBF is caused by both an increase in CVR and a decrease in CPPe, as a consequence of an increase in ZFP.

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Section: Discussionmentioning

confidence: 99%

“…This calculation of CO 2 -R indicates the percentage of the changes in CBF and V MCA per mm Hg, which is relatively independent of the particular flow levels and the PaCO 2 values. 18 …”

Section: Calculationsmentioning

confidence: 99%

Carbon Dioxide Induced Changes in Cerebral Blood Flow and Flow Velocity: Role of Cerebrovascular Resistance and Effective Cerebral Perfusion Pressure

Grüne

Kazmaier

Stolker

et al. 2015

J Cereb Blood Flow Metab

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“…Propofol reduces CBFv, CBF and cerebral metabolic demand without affecting carbon dioxide reactivity and cerebral pressure autoregulation [6,8,21,22]. A number of studies have reported a significant reduction in CBFv occurring during propofol anaesthesia [6,8,9].…”

Section: Discussionmentioning

confidence: 99%

“…We have previously demonstrated a direct effect between sevoflurane and isoflurane reducing CBFv, independent of changes in SBFv [20]. Propofol is frequently used for neuroanaesthesia owing to its ability to reduce CBFv, CBF and cerebral oxygen consumption, whilst maintaining autoregulation and carbon dioxide reactivity [9,21,22]. However, it has not been investigated whether during propofol anaesthesia the changes in CBFv correlate with changes in SBFv.…”

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confidence: 99%

A comparison of propofol and sevoflurane anaesthesia: effects on aortic blood flow velocity and middle cerebral artery blood flow velocity*

Holzer

Winter²,

Greher³

et al. 2003

Anaesthesia

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SummaryWe compared systemic (aortic) blood flow and cerebral blood flow velocity in 30 patients randomly allocated to receive either propofol or sevoflurane anaesthesia. Cerebral blood flow velocity (CBFv) was measured in the middle cerebral artery using transcranial Doppler. Systemic blood flow velocity (SBFv) was measured in the aorta using transthoracic Doppler sonography at the level of the aortic valve. Bispectral index (BIS) was used to measure the depth of anaesthesia. Measurements were made in the awake patient and repeated during propofol or sevoflurane anaesthesia, with BIS measurements of 40-50. The effects of SBFv on CBFv were estimated by calculating the cerebral ⁄ systemic blood flow velocity-index (CsvI). A CsvI value of 100 indicating a 1 : 1 relationship between CBFv and SBFv. The results demonstrated that propofol anaesthesia produced a significantly greater reduction in CsvI than did sevoflurane anaesthesia [propofol: 60 (19); sevoflurane: 83 (16), p ¼ 0.009, t-test]. This suggests a direct reduction in CBFv independent of SBFv during propofol anaesthesia. The greater reduction of CBFv occurring during propofol anaesthesia may be due to lower cerebral metabolic demand compared with sevoflurane anaesthesia at comparable depths of anaesthesia.

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“…It causes a dose-dependent decrease in intracranial pressure (ICP), while maintaining cerebral perfusion at a modest dose, and also decreases the cerebral metabolic rate without any disturbance in cerebral vascular reactivity to carbon dioxide and autoregulation. 1,2 Furthermore, propofol total intravenous anaesthesia results in a clinically relevant reduction in postoperative nausea and vomiting (PONV). However, the potentially higher cost is a concern.…”

Section: Introductionmentioning

confidence: 99%

A prospective, randomised, controlled clinical trial to evaluate the effect of nitrous oxide on propofol requirement in elective craniotomy in which entropy was used to measure depth of anaesthesia

Nanda

Prakash

Choudhury

et al. 2016

Southern African Journal of Anaesthesia and Analgesia

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Open Access article distributed under the terms of the Creative Commons License [CC BY-NC-ND 4.0] http://creativecommons.org/licenses/by-nc-nd/4.0 A prospective, randomised, controlled clinical trial to evaluate the effect of nitrous oxide on propofol requirement in elective craniotomy in which entropy was used to measure depth of anaesthesia Background: Propofol is known to have a favourable effect on cerebral haemodynamics. The role of nitrous oxide (N 2 O) in neurosurgical anaesthesia is still being debated. The primary aim of this study was to assess the dose-sparing effect of N 2 O on propofol infusion maintenance dosing. Method: Fifty American Society of Anesthesiology (ASA) grade I and II adults scheduled for elective craniotomies for supratentorial tumours were enrolled in the study. The patients received a standard anaesthetic comprising a fentanyl 2 μg/kg bolus prior to propofol induction. Anaesthesia was maintained with an infusion of fentanyl (2 μg/kg/hour), atracurium and propofol. The patients were randomised into two groups. Group A received 67% N 2 O. Group B did not receive N 2 O concomitantly with the propofol infusion. Entropy was used to guide the titration of the propofol infusion in both groups. Results: The propofol maintenance dose requirements were 47% lower in Group A (54.30 ± 11.47 μg/kg/minute) vs. Group B (102.30 ± 14.00 μg/kg/minute), (p < 0.001). Conclusion: The use of supplemental N 2 O significantly decreased propofol infusion rate requirements, compared with the propofol infusion alone, in ASA I and II patients undergoing elective supratentorial tumour excision.

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Cerebral Pressure Autoregulation and Carbon Dioxide Reactivity During Propofol-Induced EEG Suppression

Cited by 25 publications

References 26 publications

Carbon Dioxide Induced Changes in Cerebral Blood Flow and Flow Velocity: Role of Cerebrovascular Resistance and Effective Cerebral Perfusion Pressure

Carbon Dioxide Induced Changes in Cerebral Blood Flow and Flow Velocity: Role of Cerebrovascular Resistance and Effective Cerebral Perfusion Pressure

A comparison of propofol and sevoflurane anaesthesia: effects on aortic blood flow velocity and middle cerebral artery blood flow velocity*

A prospective, randomised, controlled clinical trial to evaluate the effect of nitrous oxide on propofol requirement in elective craniotomy in which entropy was used to measure depth of anaesthesia

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