Propofol decreases cerebral blood flow velocity in anesthetized children

Abstract

P Pu ur rp po os se e: : Propofol, by virtue of its favourable pharmacokinetic profile, is suitable for maintenance of anesthesia by continuous infusion during neurosurgical procedures in adults. It is gaining popularity for use in pediatric patients. To determine the effects of propofol on cerebral blood flow in children, middle cerebral artery blood flow velocity (Vmca) was measured at different levels of propofol administration by transcranial Doppler (TCD) sonography.M Me et th ho od ds s: : Twelve ASA I or II children, aged one to six years undergoing elective urological surgery were randomized to receive one of two propofol dosing regimens. Half of the patients received propofol in an escalating fashion, initially targeting an estimated steady-state serum concentration of 3 µg·mL -1 , which was then doubled. The other half received propofol designed initially to target the high concentration followed by the lower one. In each child anesthesia was induced and maintained with propofol according to the protocol, rocuronium was given to facilitate tracheal intubation, and a caudal epidural block was performed. A TCD probe was placed appropriately to measure Vmca. Cerebral blood flow velocity (CBFV), mean arterial pressure (MAP) and heart rate (HR) were recorded simultaneously at both levels of propofol administration.R Re es su ul lt ts s: : Twelve patients were studied. At the higher estimated target serum propofol concentration there were significant decreases in Vmca (17%, P < 0.001), MAP (6%, P < 0.002) and HR (8%, P < 0.05) when compared to the lower targeted concentration.C Co on nc cl lu us si io on n: : This study shows that a higher rate of propofol infusion is associated with lower CBFV and MAP values in children. Propofol's cerebral vasoconstrictive properties may be responsible for this finding. Vacm (17 %, P < 0,001), de TAM (6 %, P < 0,002) et de FC (8 %, P < 0,05) Objectif Résultats : Des baisses significatives de

Propofol: A Review of its Role in Pediatric Anesthesia and Sedation

“…This is associated with a fall in cerebral blood flow, metabolic demand for oxygen and any pre-existing cerebral edema [88, 89]. However cerebral autoregulation and cerebrovascular reactivity to CO 2 appear unaffected [90].…”

The effect of remifentanil on cerebral blood flow velocity in children anesthetized with propofol1

“…It is possible that this potentiation may have played a role in the current study. Propofol was chosen as the baseline anesthetic because of its intrinsic cerebral vasoconstrictive properties (1,2). All volatile agents have been demonstrated to cause cerebral vasodilatation, which may be associated with inferior surgical conditions compared with propofol.…”

“…It has been shown to decrease intracranial pressure and provide better surgical conditions than volatile anesthetic agents (1). This is likely due to its direct cerebral vasoconstrictive properties (2). Since propofol does not confer any analgesic effects, it is often administered with an opioid as part of a balanced anesthetic technique.…”

Desflurane increases cerebral blood flow velocity when used for rapid emergence from propofol anesthesia in children

“…The effect of propofol and desflurane on cerebral blood flow velocity (CBFV) during general anesthesia has been studied. [1][2][3][4] However, to date no studies have reported the effect of these agents during emergence from anesthesia in infants and children. Propofol has cerebral vasoconstrictive properties and appears to be ideal for neurosurgical procedures where control of intracranial pressure (ICP) is indicated.…”

“…Propofol has cerebral vasoconstrictive properties and appears to be ideal for neurosurgical procedures where control of intracranial pressure (ICP) is indicated. 1 Desflurane is a potent cerebral vasodilator and may contribute to increases in cerebral blood flow and volume. [2][3][4] This study was designed to test the null hypothesis that when propofol is replaced with desflurane for emergence from anesthesia in children, there is no effect on middle cerebral artery blood flow velocity (Vmca).…”