Journal of Anesthesia

, 22:135 | Cite as

The comparative effects of sevoflurane versus isoflurane on cerebrovascular carbon dioxide reactivity in patients with previous stroke

  • Yuji Kadoi
  • Shigeru Saito
  • Ken-Ichiro Takahashi
Original Article



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.


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·min−1.


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·s−1·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.


Our findings suggest that, in patients with previous stroke, cerebrovascular CO2 reactivity under sevoflurane anesthesia was lower than that under isoflurane anesthesia.

Key words

Cerebrovascular CO2 reactivity Previous stroke Transcranial Doppler sonography Sevoflurane Isoflurane 


  1. 1.
    Kitaguchi K, Ohsumi H, Kuro M, Nakajima T, Hayashi Y. Effects of sevoflurane on cerebral circulation and metabolism in patients with ischemic cerebrovascular disease. Anesthesiology. 1993;79:704–709.PubMedCrossRefGoogle Scholar
  2. 2.
    McPherson RW, Brian JE, Traystman RJ. Cerebrovascular responsiveness to carbon dioxide in dogs with 1.4% and 2.8% isoflurane. Anesthesiology. 1989;70:843–850.PubMedCrossRefGoogle Scholar
  3. 3.
    Nishiyama T, Matsukawa T, Yokoyama T, Hanaoka K. Cerebrovascular carbon dioxide reactivity during general anesthesia: a comparison between sevoflurane and isoflurane. Anesth Analg. 1999;89:1437–1441.PubMedCrossRefGoogle Scholar
  4. 4.
    Summors AC, Gupta AK, Matta BF. Dynamic cerebral autoregulation during sevoflurane anesthesia: a comparison with isoflurane. Anesth Analg. 1999;88:341–345.PubMedCrossRefGoogle Scholar
  5. 5.
    Maeda H, Matsumoto M, Handa N, Hougaku H, Ogawa S, Itoh T, Tsukamoto Y, Kamada T. Reactivity of cerebral blood flow to carbon dioxide in various types of ischemic cerebrovascular disease: evaluation by the transcranial Doppler method. Stroke. 1993;24:670–675.PubMedGoogle Scholar
  6. 6.
    Sugimori H, Ibayashi S, Fujii K, Sadoshima S, Kuwabara Y, Fujishima M. Can transcranial Doppler really detect reduced cerebral perfusion states? Stroke. 1995;26:2053–2060.PubMedGoogle Scholar
  7. 7.
    Meguro K, Hatazawa J, Yamaguchi T, Itoh M, Matsuzawa T, Ono S, Miyazaea H, Hishinuma T, Yanai K, Sekita Y. Cerebral circulation and oxygen metabolism associated with subclinical periventricular hyperintensity as shown by magnetic resonance imaging. Ann Neurol. 1990;28:378–383.PubMedCrossRefGoogle Scholar
  8. 8.
    Kadoi Y, Takahashi K, Saito S, Goto F. The comparative effects of sevoflurane versus isoflurane on cerebrovascular carbon dioxide reactivity in patients with diabetes mellitus. Anesth Analg. 2006;103:168–172.PubMedCrossRefGoogle Scholar
  9. 9.
    Kadoi Y, Saito S, Fujita N, Goto F. Risk factors for cognitive dysfunction after coronary artery bypass graft surgery in patients with type 2 diabetes. J Thorac Cardiovasc Surg. 2005;129:576–583.PubMedCrossRefGoogle Scholar
  10. 10.
    Kadoi Y, Hinohara H, Kunimoto F, Saito S, Ide M, Hiraoka H, Kawahara F, Goto F. Diabetic patients have an impaired cerebral vasodilatory response to hypercapnia under propofol anesthesia. Stroke. 2003;34:2399–23403.PubMedCrossRefGoogle Scholar
  11. 11.
    Hinohara H, Kadoi Y, Takahashi K, Saito S, Goto F. Cerebrovascular carbon dioxide reactivity in patients with former stroke under propofol anesthesia. J Clin Anesth. 2004;16:483–487.PubMedCrossRefGoogle Scholar
  12. 12.
    Kadoi Y, Ide M, Saito S, Shiga T, Ishizaki K, Goto F. Hyperventilation after tourniquet deflation prevents an increase in cerebral blood flow velocity. Can J Anaesth. 1999;46:259–264.PubMedCrossRefGoogle Scholar
  13. 13.
    Olsen KS, Henriksen L, Owen-Falkengerg A, Dige-Petersen H, Rosemon J, Chraemmer-Jorgensen B. Effect of 1 or 2 MAC isoflurane with or without ketanserin on cerebral blood flow autoregulation in man. Br J Anaesth. 1994;72:66–71.PubMedCrossRefGoogle Scholar
  14. 14.
    Lundar T, Lindegaard KF, Refsum L, Rian R, Nornes H. Cerebrovascular effects of isoflurane in man. Br J Anaesth. 1987;59:1208–1213.PubMedCrossRefGoogle Scholar
  15. 15.
    Gupta S, Heath K, Matta BF. Effect of incremental doses of sevoflurane on cerebral pressure autoregulation in humans. Br J Anaesth. 1997;79:469–472.PubMedGoogle Scholar
  16. 16.
    Scheller MS, Nakakimura K, Fleischer JE, Zornow MH. Cerebral effects of sevoflurane in the dog: comparison with isoflurane and enflurane. Br J Anaesth. 1990;65:388–392.PubMedCrossRefGoogle Scholar
  17. 17.
    Lam AM, Mayberg TS, Eng CC, Cooper JO, Bachenberg KL, Hathisen TL. Nitrous oxide-isoflurane anesthesia causes more cerebral vasodilation than an equipotent dose of isoflurane in humans. Anesth Analg. 1994;78:462–468.PubMedCrossRefGoogle Scholar
  18. 18.
    Kawaguchi M, Furuya H, Kurehara K, Yamada M. Effects of nicardipine on cerebral vascular responses to hypocapnia and blood flow velocity in the middle cerebral artery. Stroke. 1991;22:1170–1172.PubMedGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2008

Authors and Affiliations

  • Yuji Kadoi
    • 1
  • Shigeru Saito
    • 1
  • Ken-Ichiro Takahashi
    • 2
  1. 1.Department of AnesthesiologyGunma University HospitalGunmaJapan
  2. 2.Department of AnesthesiaTone Central HospitalGunmaJapan

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