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Cerebral vascular reactivity response to anaesthetic induction with propofol in patients with intracranial space-occupying lesions and vascular malformations

Published online by Cambridge University Press:  11 July 2005

K. Schmieder ,
W. Schregel ,
M. Engelhardt ,
A. Harders  and
G. Cunitz
K. Schmieder
Affiliation:
Ruhr-University Bochum, Department of Neurosurgery, Bochum, Germany
W. Schregel
Affiliation:
Ruhr-University Bochum, Department of Anaesthesiology, Bochum, Germany
M. Engelhardt
Affiliation:
Ruhr-University Bochum, Department of Neurosurgery, Bochum, Germany
A. Harders
Affiliation:
Ruhr-University Bochum, Department of Neurosurgery, Bochum, Germany
G. Cunitz
Affiliation:
St-Josef Hospital, Department of Anaesthesiology, Krefeld, Germany
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Extract

Summary

Background and objective: In clinical trials, autoregulation and carbon dioxide reactivity are preserved during propofol anaesthesia. Paradoxical increases of blood flow velocity during induction of anaesthesia could be demonstrated in patients with brain tumours. This study evaluates the effects of propofol on cerebral blood flow velocity in patients undergoing surgery for brain tumours and vascular malformations.

Methods: Changes in cerebral blood flow velocity after the administration of propofol were assessed using bilateral 2 MHz transcranial Doppler probes in 47 patients undergoing surgery for brain tumours and in 22 patients undergoing surgery for aneurysms and angiomas.

Results: Flow reduction after propofol was slightly less pronounced on the side of the tumour; in patients with cerebrovascular lesions, no difference between the two sides was detectable. After the administration of propofol a flow increase was present on the side of the tumour in 2 patients. In 3 patients with angiomas, the flow decrease after the administration of propofol was less pronounced on the side of the angioma. Neither observation gave statistical proof of abnormality.

Conclusions: The flow changes after propofol may give a hint of cerebrovascular reactivity. Further investigations should focus on combined measurements of cerebral autoregulation and carbon dioxide reactivity and should focus on patients with impaired consciousness to test for reliability.

Keywords

ANAESTHETICS, intravenous, propofolMONITORING, Doppler sonographySURGERY, neurological
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 6 , June 2003 , pp. 457 - 460
Copyright
© 2003 European Society of Anaesthesiology

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References

Van Aken H, van Hemelrijck J, Merckx L, Mollhoff T, Mulier J, Lubbesmeyer HJ. Total intravenous anaesthesia using propofol and alfentanil in comparison with balanced anaesthesia in neurosurgery. Anästh Intensivther Notfallmed 1990; 25: 54–58.Google Scholar
Boishardy N, Chapotte C, Houi N, Poirier T, Granry JC, Delhumeau A. The effect of a combination of propofol and fentanyl on cerebral blood flow. A study using transcranial Doppler. Can Anaesth Soc J 1992; 40: 23–25.Google Scholar
Fischer M, Moskopp D, Nadstawek J, Ries F. Total intravenous anaesthesia using propofol and alfentanil as compared to combined inhalation anaesthesia reduces the flow velocity in the middle cerebral artery: a Doppler sonographic study. Anaesthesist 1992; 41: 15–20.Google Scholar
Van Hemelrijck J, Fitch W, Mattheussen M, Van Aken H, Plets C, Lauwers J. Effect of propofol on cerebral circulation and autoregulation in the baboon. Anesth Analg 1990; 71: 49–54.Google Scholar
Werner C, Hoffman WE, Kochs E, Schulte am Esch J, Albrecht RF. The effects of propofol on cerebral and spinal cord blood flow in rats. Anesth Analg 1993; 76: 971–975.Google Scholar
Akeson J, Messeter K, Rosen I, Bjorkman S. Cerebral haemodynamics and electrocortical CO2-reactivity in pigs anaesthetized with fentanyl, nitrous oxide and pancuronium. Acta Anaesthesiol Scand 1993; 37: 85–91.Google Scholar
Salord F, Naous H, Rizk T, et al. Cerebrovascular reactivity to CO2 during anesthesia maintained with either isoflurane-N2O or propofol N2O. A comparative study by transcranial Doppler velocimetry. Ann Fr Anesth Reanim 1995; 14: 166–171.Google Scholar
Strebel S, Lam AM, Matta B, Mayberg TS, Aaslid R, Newell DW. Dynamic and static cerebral autoregulation during isoflurane, desflurane, and propofol anesthesia. Anesthesiology 1995; 83: 66–76.Google Scholar
Schregel W, Geißler C, Winking M, Schaefermeyer H, Cunitz G. Transcranial Doppler monitoring during induction of anesthesia: effects of propofol, thiopental, and hyperventilation in patients with large malignant brain tumors. J Neurosurg Anesthesiol 1993; 5: 86–93.Google Scholar
Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysm. J Neurosurg 1968; 28: 14–20.Google Scholar
Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid haemorrhage visualized by computerized tomographic scanning. Neurosurgery 1980; 6: 1–9.Google Scholar
Beaney RP, Brooks DJ, Leenders KL, Thomas DGT, Jones R, Halnan KE. Blood flow and oxygen utilization in the contralateral cerebral cortex of patients with untreated intracranial tumors as studied by positron emission tomography, with observation on the effect of decompressive surgery. J Neurol Neurosurg Psychiat 1985; 48: 331–335.Google Scholar
Kuroda K, Olsen TS, Lassen NA. Regional cerebral blood flow in various types of brain tumour. Acta Neurol Scand 1982; 66: 160–171.Google Scholar
Palvölgyi R. Regional cerebral blood flow in patients with intracranial tumors. J Neurosurg 1969; 31: 149–163.Google Scholar
Hassler W, Steinmetz H. Cerebral hemodynamics in angioma patients: in intraoperative study. J Neurosurg 1987; 67: 822–831.Google Scholar
De Salles AAF, Manchola I. CO2 reactivity in arteriovenous malformations of the brain: a transcranial Doppler ultrasound study. J Neurosurg 1994; 80: 624–630.Google Scholar