Document Detail

The comparative effects of sevoflurane versus isoflurane on cerebrovascular carbon dioxide reactivity in patients with previous stroke.
MedLine Citation:
PMID:  18500610     Owner:  NLM     Status:  MEDLINE    
PURPOSE: The use of volatile anesthetics is reportedly related to altered cerebrovascular carbon dioxide (CO2) reactivity. We examined the comparative effects of sevoflurane versus isoflurane on cerebrovascular CO2 reactivity in patients with previous stroke. METHODS: Twenty-four patients with previous stroke and 20 patients without previous stroke (serving as controls) were studied. Anesthesia was maintained with either end-tidal 1.0 minimum alveolar concentration (MAC) sevoflurane or 1.0 MAC isoflurane in 33% oxygen and 67% nitrous oxide. A 2.5-MHz pulsed transcranial Doppler (TCD) probe was attached to the patient's head at the right or left temporal window for continuous measurement of mean blood flow velocity in the middle cerebral artery (Vmca). After establishing baseline values of Vmca and cardiovascular hemodynamics, we increased end-tidal CO2 by decreasing the ventilatory frequency by 2-5 breaths x min(-1). RESULTS: We found that values for absolute and relative CO2 reactivity in the sevoflurane groups were lower than those in the isoflurane groups (absolute CO2 reactivity in the sevoflurane groups: control, 3.3 +/- 0.4*; previous stroke, 3.4 +/- 0.4*; absolute CO2 reactivity in the isoflurane groups: control, 4.2 +/- 0.3; previous stroke, 4.5 +/- 0.4, cm x s(-1) x mmHg(-1); *P < 0.05 compared with isoflurane group). There were no significant differences in the values for absolute and relative CO2 reactivity between the controls and the previous-stroke patients within each of the sevoflurane and isoflurane groups. CONCLUSION: Our findings suggest that, in patients with previous stroke, cerebrovascular CO2 reactivity under sevoflurane anesthesia was lower than that under isoflurane anesthesia.
Yuji Kadoi; Shigeru Saito; Ken-ichiro Takahashi
Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2008-05-25
Journal Detail:
Title:  Journal of anesthesia     Volume:  22     ISSN:  0913-8668     ISO Abbreviation:  J Anesth     Publication Date:  2008  
Date Detail:
Created Date:  2008-05-26     Completed Date:  2008-10-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8905667     Medline TA:  J Anesth     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  135-9     Citation Subset:  IM    
Department of Anesthesiology, Gunma University Hospital, Maebashi, Gunma, Japan.
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MeSH Terms
Anesthesia, General
Anesthesia, Inhalation
Anesthetics, Inhalation / pharmacology*
Blood Flow Velocity / drug effects
Carbon Dioxide / analysis,  metabolism*
Cerebrovascular Circulation / drug effects*
Isoflurane / pharmacology*
Methyl Ethers / pharmacology*
Middle Aged
Monitoring, Intraoperative
Nitrous Oxide / pharmacology
Prospective Studies
Stroke / physiopathology*,  surgery
Ultrasonography, Doppler, Transcranial
Reg. No./Substance:
0/Anesthetics, Inhalation; 0/Methyl Ethers; 10024-97-2/Nitrous Oxide; 124-38-9/Carbon Dioxide; 26675-46-7/Isoflurane; 28523-86-6/sevoflurane

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