Document Detail


The cerebrovascular response to hypocapnia in children receiving propofol.
MedLine Citation:
PMID:  15385348     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Hypocapnia is used to treat acute increases in intracranial pressure during neurosurgery. Cerebrovascular reactivity to carbon dioxide (CCO(2)R) is preserved above 35 mm Hg ETco(2) in children during propofol anesthesia; however, a plateau effect has been suggested below 35 mm Hg. To further delineate this phenomenon, we measured CCO(2)R by transcranial Doppler (TCD) sonography over small increments in ETco(2) in 27 healthy children. Anesthesia comprised a standardized propofol infusion and a caudal epidural block. A TCD probe was placed to measure middle cerebral artery blood flow velocity (V(mca)). ETco(2) was adjusted between 24 and 40 mm Hg at 1-2 mm Hg increments using an exogenous source of CO(2). There was an exponential relationship between ETco(2) and V(mca) above an ETco(2) value of 30 mm Hg (r = 0.82). However, V(mca) did not change with ETco(2) less than 30 mm Hg (r = 0.06). There were no significant changes in heart rate or arterial blood pressure. We conclude that when contemplating methods to decrease brain volume and intracranial pressure, hyperventilation to ETco(2) values less than 30 mm Hg may not be necessary in children receiving propofol, as no further reduction in cerebral blood flow velocity will be achieved.
Authors:
Cengiz Karsli; Igor Luginbuehl; Bruno Bissonnette
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  99     ISSN:  0003-2999     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2004 Oct 
Date Detail:
Created Date:  2004-09-23     Completed Date:  2004-10-18     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1049-52, table of contents     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesia, The Hospital for Sick Children, University of Toronto, Ontario, Canada. cengiz.karsli@sickkids.ca
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MeSH Terms
Descriptor/Qualifier:
Anesthesia, Intravenous / adverse effects*
Anesthetics, Intravenous / adverse effects*
Carbon Dioxide / blood
Cerebrovascular Circulation / drug effects*
Child, Preschool
Female
Hemodynamics / physiology
Humans
Hypocapnia / physiopathology*
Infant
Male
Middle Cerebral Artery / physiology
Monitoring, Intraoperative
Propofol / adverse effects*
Ultrasonography, Doppler, Transcranial
Chemical
Reg. No./Substance:
0/Anesthetics, Intravenous; 124-38-9/Carbon Dioxide; 2078-54-8/Propofol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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