Document Detail


A randomized crossover comparison of the effects of propofol and sevoflurane on cerebral hemodynamics during carotid endarterectomy.
MedLine Citation:
PMID:  17197845     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Intravenous and inhalational anesthetic agents have differing effects on cerebral hemodynamics: Sevoflurane causes some vasodilation, whereas propofol does not. The authors hypothesized that these differences affect internal carotid artery pressure (ICAP) and the apparent zero flow pressure (critical closing pressure) during carotid endarterectomy. Vasodilation is expected to increase blood flow, reduce ICAP, and reduce apparent zero flow pressure. METHODS: In a randomized crossover study, the gradient between systemic arterial pressure and ICAP during carotid clamping was measured while changing between sevoflurane and propofol in 32 patients. Middle cerebral artery blood velocity, recorded by transcranial Doppler, and ICAP waveforms were analyzed to determine the apparent zero flow pressure. RESULTS: ICAP increased when changing from sevoflurane to propofol, causing the mean gradient between arterial pressure and ICAP to decrease by 10 mmHg (95% confidence interval, 6-14 mmHg; P<0.0001). Changing from propofol to sevoflurane had the opposite effect: The pressure gradient increased by 5 mmHg (95% confidence interval, 2-7 mmHg; P=0.002). Ipsilateral middle cerebral artery blood velocity decreased when changing from sevoflurane to propofol. Cerebral steal was detected in one patient after changing from propofol to sevoflurane. The apparent zero flow pressure (mean+/-SD) was 22+/-10 mmHg with sevoflurane and 30+/-14 mmHg with propofol (P<0.01). There was incomplete drug crossover due to the limited duration of carotid clamping. CONCLUSIONS: Compared with sevoflurane, ipsilateral ICAP and apparent zero flow pressure are both higher with propofol. Vasodilatation associated with sevoflurane can cause cerebral steal.
Authors:
Timothy J McCulloch; Christopher L Thompson; Martin J Turner
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesiology     Volume:  106     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  2007 Jan 
Date Detail:
Created Date:  2007-01-01     Completed Date:  2007-02-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  56-64     Citation Subset:  AIM; IM    
Affiliation:
Department of Anaesthetics, University of Sydney, Sydney, and Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. tmccull@usyd.edu.au
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MeSH Terms
Descriptor/Qualifier:
Anesthetics, Inhalation / pharmacology*
Anesthetics, Intravenous / pharmacology*
Blood Pressure / drug effects
Carotid Artery, Internal / physiology
Cerebrovascular Circulation / drug effects*
Cross-Over Studies
Endarterectomy, Carotid*
Humans
Methyl Ethers / pharmacology*
Middle Cerebral Artery / physiology
Propofol / pharmacology*
Ultrasonography, Doppler, Transcranial
Chemical
Reg. No./Substance:
0/Anesthetics, Inhalation; 0/Anesthetics, Intravenous; 0/Methyl Ethers; 2078-54-8/Propofol; 28523-86-6/sevoflurane

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


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