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Distribution of Cerebral Blood Flow During Anesthesia with Isoflurane Or Halothane in Humans

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Distribution of Cerebral Blood Flow During Anesthesia with Isoflurane Or Halothane in Humans Ovid: Distribution of Cerebral Blood Flow during Anesthesia with Isoflurane or Halothane in Humans. Main Search Page Ask A LibrarianDisplay Knowledge BaseHelpLogoff Full Text Save Article TextEmail Article TextPrint Preview Distribution of Cerebral Blood Flow during Anesthesia with Isoflurane or Halothane in Humans Reinstrup, Peter MD, PhD; Ryding, Erik MD, PhD; Algotsson, Lars MD, PhD; Messeter, Kenneth ISSN: Author(s): MD, PhD; Asgeirsson, Bogi MD; Uski, Tore MD, PhD 0003- 3022 Issue: Volume 82(2), February 1995, pp 359-366 Accession: Publication Type: [Clinical Investigation] 00000542- Publisher: © 1995 American Society of Anesthesiologists, Inc. 199502000- Received from the Departments of (Reinstrup, Algotsson, Messeter, Asgeirsson) 00006 Anesthesiology, (Reinstrup, Uski) Clinical Pharmacology, (Ryding) Clinical Neurophysiology, Email and (Uski) Neurosurgery, University Hospital, Lund, Sweden. Submitted for publication March Jumpstart 23, 1994. Accepted for publication October 7, 1994. Supported by grants from Tore Nilssons Find Institution(s): foundation for medical research, Swedish Medical Research Council (B91-14X-00084-27A), Citing Malmohus Ians landsting, and Research funds of the University of Lund, Presented in part at Articles BRAIN 93, Sendai, Japan, May 1993. ≪ Address reprint requests to Dr. Reinstrup: Department of Anesthesia. University Hospital of Table Lund, 221 85 Lund, Sweden. of Table of Contents: Contents About ≪ An Evaluation of the Effect of Anesthetic Technique on Reproductive Success after Laparoscopic this Pronuclear Stage Transfer: Propofol/Nitrous Oxide Versus Isoflurane/Nitrous Oxide. ≫ Death and Other Complications of Emergency Airway Management in Critically Ill Adults: A Prospective Journal Investigation of 297 Tracheal Intubations. ≫ Abstract Links Background: Halothane and isoflurane have been shown to induce disparate effects Abstract on different brain structures in animals. In humans, various methods for Complete Reference measuring cerebral blood flow (CBF) have produced results compatible with ExternalResolverBasic a redistribution of CBF toward deep brain structures during isoflurane anesthesia Outline in humans. This study was undertaken to examine the effects of halothane and isoflurane on the distribution of CBF. ● Abstract Methods: Twenty ASA physical status patients (four groups, five in each) ● Materials and Methods anesthetized with either isoflurane or halothane (1 MAC) during normo- or ❍ Experimental Procedure hypocapnia (PaCO2 5.6 or 4.2 kPa (42 or 32 mmHg)) were investigated with a ❍ 133 Measurement of Mean CBF two-dimensional CBF measurement (CBFxenon, intravenous xenon ❍ Measurement of Three- washout technique) and a three-dimensional method for measurement of the http://ovidsp.tx.ovid.com/spb/ovidweb.cgi (1 of 12) [6/2/2008 4:15:10 PM] Ovid: Distribution of Cerebral Blood Flow during Anesthesia with Isoflurane or Halothane in Humans. dimensional CBF Distribution regional CBF (rCBF) distribution with single photon emission computer- ❍ Calculations and Statistical aided tomography (SPECT;99m Tc-HMPAO). In the presentation of SPECT data, Methods the mean CBF of the brain was defined as 100%, and all relative flow values are related to this value. ● Results ❍ Effects of Halothane and Results: The mean CBFxenon level was significantly influenced by the PaCO2 as well Isoflurane on Mean CBF sub as by the anesthetic used. At normocapnia, patients anesthetized with halothane xenon Level Using sup 133 had a mean CBFxenon of 40 plus/minus 3 (SE) ISI units. With isoflurane, the flow Xenon was significantly (P < 0.01, 33 plus/minus 3 ISI units) less than with ❍ Effects of Halothane and halothane. Hypocapnia decreased mean CBF (P < 0.0001) during both Isoflurane on the Three- xenon dimensional CBF Distribution anesthetics (halothane 24 plus/minus 3, isoflurane 13 plus/minus 2 ISI units). The effects on CBFxenon, between the anesthetics, differed significantly (P < ● Discussion 0.01) also during hypocapnia. There were significant differences in rCBF ● REFERENCES distribution measured between the two anesthetics (P < 0.05). During isoflurane anesthesia, there was a relative increase in flow values in Graphics subcortical regions (thalamus and basal ganglia) to 10-15%, and in pons to 7- 10% above average. Halothane, in contrast, induced the highest relative flow levels in the occipital lobes, which increased by approximately 10% above average. The ● Table 1 rCBF level was increased approximately 10% in cerebellum with both ● Figure 1 anesthetics. Changes in PaCO2 did not alter the rCBF distribution significantly. ● Figure 2 ● Figure 3 Conclusions: There is a difference in the human rCBF distribution between ● Figure 4 halothane and isoflurane with higher relative flows in subcortical regions during isoflurane anesthesia. However, despite this redistribution, isoflurane anesthesia resulted in a lower mean CBFxenon than did anesthesia with halothane. Key words: Anesthetics, volatile: halothane; isoflurane. Brain: cerebral blood flow; regional cerebral blood flow. Carbon dioxide: hypocapnia; normocapnia. Measurement technique: single photon emission computer-aided tomography (SPECT). ALTHOUGH isoflurane is thought to be the volatile anesthetic of choice for patients undergoing intracranial surgery, its superiority to halothane has been questioned lately. The diminished cortical cerebral blood flow (CBF) found during isoflurane anesthesia [1,2] may cause a redistribution to central brain structures as found in rabbit [3] and implied in rat. [4] However, because Young et al. [5] failed to reproduce these findings in the rat, this isoflurane-induced redistribution of CBF is still debated. Using tomographic techniques, such as single photon emission computer-aided tomography (SPECT), three-dimensional studies of regional CBF (rCBF) are possible. Like a computed tomography scanner, these techniques provides slices through the brain that represent a picture of the flow. The technique is based on injection of a radioactive tracer, e.g., technetium-99m- hexamethyl-propylene amine oxime (sup 99m Technetium-HMPAO), which gives an image of the distribution of the flow at the time of injection. With these methods, not only the cortical but also subcortical regions can be studied. Intraoperative SPECT studies have been performed in patients undergoing carotid endarterectomy [6] during fentanyl/isoflurane anesthesia. To our knowledge, no data concerning rCBF in halothane-anesthetized patients are available. http://ovidsp.tx.ovid.com/spb/ovidweb.cgi (2 of 12) [6/2/2008 4:15:10 PM] Ovid: Distribution of Cerebral Blood Flow during Anesthesia with Isoflurane or Halothane in Humans. To examine whether CBF redistribution occurs in humans, we evaluated the effect of halothane and isoflurane on the absolute level of CBF determined by intravenous133 xenon [7] combined with measurements of the rCBF distribution with SPECT and99m Tc-HMPAO. Materials and Methods Twenty male patients, ASA physical status 1, scheduled for inguinal herniorrhaphy participated in the study. The protocol was approved by the ethics committee for human studies and the isotope committee at the University of Lund. Written informed consent was obtained from each participant. Experimental Procedure The 20 patients were randomly allocated into one of the following four groups, with 5 in each group, to receive 1 MAC halothane during normo- or hypocapnia or 1 MAC isoflurane during normo- or hypocapnia. No premedication was given. Anesthesia was induced with 0.75 mg/kg intravenous meperidine and 2-2.5 mg/kg propofol. Succinylcholine (1 mg/kg) was used to facilitate tracheal intubation. Anesthesia was maintained with halothane or isoflurane in 60-70% N2 O in oxygen. Throughout anesthesia, end-tidal concentrations of halothane, isoflurane, and carbon dioxide (ETCO2) were kept as close as possible to the final experimental condition. Mechanical ventilation was accomplished with a Servo ventilator (Siemens 900 B. Siemens Elema, Solna, Sweden). ETCO2, as well as concentrations of volatile anesthetics, were recorded on a Normocap 102-24-02 and a Normac gas monitor (Datex, Helsinki, Finland), respectively. Nitrous oxide was discontinued 10-20 min before the end of surgery, and the patients were kept anesthetized with 1 MAC halothane or isoflurane in 30% oxygen for at least 30 min. When stable conditions were achieved, mean CBF was measured 133 99m using radioactive xenon clearance (CBFxenon). Tc-HMPAO was injected immediately after the CBFxenon measurement, and anesthesia was maintained for 5 min more. No patient was studied sooner than 60 min after the induction of anesthesia. After a postanaesthetic recovery period of 1-2 h, the patients were brought to the neurophysiologic department for SPECT scanning. During measurement of the mean CBFxenon, hemoglobin concentration and arterial blood gas samples was analyzed using an ABL 500 (Radiometer, Copenhagen, Denmark). Temperature, pulse, and arterial blood pressure were monitored. Measurement of Mean CBF 133 Measurement of mean CBFxenon was performed with injection of 0.5 Gbq (10 mCi) xenon in a cubital vein, followed by a rapid injection of 20 ml of isotonic saline. The uptake and clearance of the tracer substance was recorded with a scintillation detector with a wide collimation (about 90 degrees view) placed on the right side of the head over the parietotemporal region, including most of the brain in its field. Clearance through the lungs was recorded from the expired air. A Novo Cerebrograph 10a
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