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Effects of sevoflurane on intracranial pressure, cerebral blood flow and cerebral metabolism: A dose‐response study in patients subjected to craniotomy for cerebral tumours
Author(s) -
Bundgaard H.,
Oettingen G.,
Larsen K. M.,
Landsfeldt U.,
Jensen K. A.,
Nielsen E.,
Cold G. E.
Publication year - 1998
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.1998.tb05292.x
Subject(s) - sevoflurane , medicine , cerebral blood flow , normocapnia , anesthesia , craniotomy , intracranial pressure , propofol , fentanyl , hemodynamics , hypercapnia , acidosis
Background: Studies concerning the cerebrovascular effects of sevoflurane in patients with space‐occupying lesions are few. This study was carried out as a dose‐response study comparing the effects of increasing sevoflurane concentration (1.5% (0.7 MAC) to 2.5% (1.3 MAC)) on cerebral blood flow (CBF), intracranial pressure (ICP), cerebrovascular resistance (CVR), metabolic rate of oxygen (CMRO 2 ) and CO 2 ‐reactivity in patients subjected to craniotomy for supratentorial brain tumours. Methods: Anaesthesia was induced with propofol/fentanyl/atracurium and maintained with 1.5% sevoflurane in air/oxygen at normocapnia. Blood pressure was maintained constant by ephedrine. In group 1 (n=10), the patients received continuously 1.5% sevoflurane. Subdural ICP, CBF and CMRO 2 were measured twice at 30‐min intervals. In group 2 (n=10), sevoflurane concentration was increased from 1.5% to 2.5% after CBF 1 . CBF 2 was measured after 20 min during 2.5% sevoflurane. Finally, CO 2 ‐reactivity was studied in both groups. Results: In group 1, no time‐dependent alterations in CBF, CVR, ICP and CMRO 2 were found. In group 2, an increase in sevoflurane from 1.5% to 2.5% resulted in an increase in CBF from 29 ± 10 to 34±12 ml 100g −1 min −1 and a decrease in CVR from 2.7±0.9 to 2.3±1.2 mmHg ml −1 min 100g ( P <0.05), while ICP and CMRO 2 were unchanged. CO 2 ‐reactivity was maintained at 1.5% and 2.5% sevoflurane. Conclusion: Sevoflurane is a cerebral vasodilator in patients with cerebral tumours. Sevoflurane increases CBF and decreases CVR in a dose‐dependent manner. CO 2 ‐reactivity is preserved during 1.5% and 2.5% sevoflurane.