Effect of propofol and remifentanil on cerebral perfusion and oxygenation in pigs: a systematic review

Abstract

The objective of this review is to evaluate the existing literature with regard to the influence of propofol and remifentanil total intravenous anaesthesia (TIVA) on cerebral perfusion and oxygenation in healthy pigs. Anaesthesia has influence on cerebral haemodynamics and it is important not only in human but also in veterinary anaesthesia to preserve optimal regulation of cerebral haemodynamics. Propofol and remifentanil are widely used in neuroanaesthesia and are increasingly used in experimental animal studies. In translational models, the pig has advantages compared to small laboratory animals because of brain anatomy, metabolism, neurophysiological maturation, and cerebral haemodynamics. However, reported effects of propofol and remifentanil on cerebral perfusion and oxygenation in pigs have not been reviewed. An electronic search identified 99 articles in English. Title and abstract screening selected 29 articles for full-text evaluation of which 19 were excluded with reasons. Of the 10 peer-reviewed articles included for review, only three had propofol or remifentanil anaesthesia as the primary study objective and only two directly investigated the effect of anaesthesia on cerebral perfusion and oxygenation (CPO). The evidence evaluated in this systematic review is limited, not focused on propofol and remifentanil and possibly influenced by factors of potential importance for CPO assessment. In one study of healthy pigs, CPO measures were within normal ranges following propofol-remifentanil anaesthesia, and addition of a single remifentanil bolus did not affect regional cerebral oxygen saturation (rSO2). Even though the pool of evidence suggests that propofol and remifentanil alone or in combination have limited effects on CPO in healthy pigs, confirmative evidence is lacking.

The effect of dexmedetomidine on cerebral perfusion and oxygenation in healthy piglets with normal and lowered blood pressure anaesthetized with propofol-remifentanil total intravenous anaesthesia

“…The baseline MAP was comparable to findings in other studies based on propofol-remifentanil in pigs [ 60 ], even though it was relatively low. The significant difference in MAP between the NBP and the LBP group was consequently clinically small, but the difference was consistent and statistically significant throughout the experiment.…”

Loss of Female Sex Hormones Exacerbates Cerebrovascular and Cognitive Dysfunction in Aortic Banded Miniswine Through a Neuropeptide Y–Ca 2+ ‐Activated Potassium Channel–Nitric Oxide Mediated Mechanism

“…In the second session, anesthesia was induced with a mixture of Telazol/xylazine (5 and 2.25 mg/kg, respectively) and maintained using propofol (6–10 mg/kg per minute). At this dose, propofol does not impair cerebral autoregulation in pigs . Pigs were placed in the supine position, and cardiac output and EF% (5F admittance‐based ADVantage catheter inserted into the left ventricle through an apical incision) as well as heart rate (ECG) and MAP (fluid‐filled 6F arterial catheter) were measured.…”

“…At this dose, propofol does not impair cerebral autoregulation in pigs. 28,29 Pigs were placed in the supine position, and cardiac output and EF% (5F admittance-based ADVantage catheter inserted into the left ventricle through an apical incision) as well as heart rate (ECG) and MAP (fluid-filled 6F arterial catheter) were measured. Carotid artery blood flow (%2 cm inferior to the bifurcation) was measured using Doppler ultrasonography, as previously published.…”

Microvascular insulin resistance in skeletal muscle and brain occurs early in the development of juvenile obesity in pigs

“…Pigs were sedated first using a Telazol (5 mg/kg)-xylazine (2.25 mg/kg) mixture, and anesthesia was maintained using propofol (6 -15 mg•kg Ϫ1 •min Ϫ1 iv). At this dose, propofol does not impair cerebral autoregulation in pigs (53,67). Blood was sampled from the jugular vein in an EDTA-coated Vacutainer and centrifuged at 4°C at 5,000 rpm for 10 min, and the plasma was stored for future analysis.…”