Abstract
Purpose
To investigate the influence of PaCO2 manipulation on the cerebral hemodynamic response to surgical stimulation.
Methods
Twenty-one female patients undergoing elective gynecological surgery performed through a lower median abdominal incision were enrolled. After obtaining steady general anesthesia with 1.7% sevoflurane and 60% nitrous oxide, the patients were randomly assigned to three groups, hypocapnia (PaCO2 = 30 mmHg), normocapnia (PaCO2=38 mmHg), and hypercapnia (PaCO2=44 mmHg) groups. The changes in mean blood flow velocity in the middle cerebral artery (Vmca) were evaluated using transcranial Doppler ultrasonography during nine minutes after surgical incision.
Results
The change in Vmca (Δ Vmca) with surgical incision during hypercapnia (30–36 cm·sec−1) was significantly greaterthan during normocapnia (20–22 cm·sec−1) and hypocapnia (13–15 cm·sec−1). The Δ Vmca in the hypocapnia group was significantly smaller than in the normocapnia group. Arterial blood pressure increased with incision but there was no significant difference among the three groups.
Conclusion
Cerebral hemodynamic changes evoked by surgical stimulation are attenuated by hypocapnia and are augmented by hypercapnia, even within a clinically relevant range of PaCO2.
Résumé
Objectif
Rechercher l’influence de la manipulation de la PaCO2 sur la réaction hémodynamique cérébrale à la stimulation chirurgicale.
Méthode
Vingt et une patientes devant subir une intervention gynécologique, réalisée par incision médiane abdominale basse, ont été recrutées. Lanesthésie générale étant stabilisée avec du sévoflurane à 1,7 % et du protoxyde d’azote à 60 %, nous avons réparti les patientes en trois groupes: hypocapnie (PaCO2 = 30 mmHg), normocapnie (PaCO2 = 38 mmHg) et hypercapnie (PaCO2 = 44 mmHg). Les changements de vitesse du flux sanguin moyen de l’artère cérébrale médiane (Vacm) ont été évalués en utilisant l’échographie Doppler transcrânienne pendant neuf minutes après l’incision chirurgicale.
Résultats
Les changements de Vacm (Δ Vacm) provoqués par l’incision chirurgicale pendant l’hypercapnie (30–36 cm·secr−1) ont été significativement plus importants que pendant la normocapnie (20–22 cm·sec−1) et l’hypocapnie (13–15 cm·sec−1). La Δ Vacm a été significativement plus faible avec hypocapnie qu’avec normocapnie. La tension artérielle a augmenté avec l’incision, mais il n’y a pas eu de différence intergroupe significative.
Conclusion
Les changements hémodynamiques cérébraux provoqués par la stimulation chirurgicale sont atténués par l’hypocapnie et augmentés par l’hypercapnie, même en se confinant dans des limites cliniques acceptables de PaCO2.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Ibayashi S, Ngai AC, Howard IIIMA, Meno JR, Mayberg MR, Winn HR. Lack of sympathetic and cholinergic influences on cerebral vasodilation caused by sciatic nerve stimulation in the rat. J Cereb Blood Flow Metab 1991; 11: 678–83.
Ngai AC, Ko KR, Morii S, Winn HR. Effect of sciatic nerve stimulation on pial arterioles in rats. Am J Physiol 1988; 254: H133–9.
Brian JE Jr. Carbon dioxide and the cerebral circulation. Anesthesiology 1998; 88: 1365–86.
Bishop CCR, Powell S, Rutt D, Browse NL. Transcranial Doppler measurement of middle cerebral artery blood flow velocity: a validation study. Stroke 1986; 17: 913–5.
Bryan RM Jr. Cerebral blood flow and energy metabolism during stress. Am J Physiol 1990; 259: H269–80.
Fox FT, Raichle ME. Focal physiological uncoupling of cerebral blood flow and oxidative metabolism during somatosensory stimulation in human subjects. Proc Natl Acad Sci USA 1986; 83: 1140–4.
Fox FT, Raichle ME, Mintun MA, Dence C. Nonoxidative glucose consumption during focal physiologic neural activity. Science 1988; 241: 462–4.
Inada T, Shingu K, Uchida M, Kawachi S, Tsushima K, Niitsu T Changes in the cerebral arteriovenous oxygen content difference by surgical incision are similar during sevoflurane and isoflurane anaesthesia. Can J Anaesth 1996; 43: 1019–24.
Kuramoto T, Oshita S, Takeshita H, Ishikawa T Modification of the relationship between cerebral metabolism, blood flow, and electroencephalogram by stimulation during anesthesia in the dog. Anesthesiology 1979; 51: 211–7.
Miyauchi Y, Sakabe T, Maekawa T, Ishikawa T, Takeshita H. Responses of EEG, cerebral oxygen consumption and blood flow to peripheral nerve stimulation during thiopentone anaesthesia in the dog. Can Anaesth Soc J 1985; 32: 491–8.
Rotzen MF, Horrigan RW, Frazer BM. Anesthetic doses blocking adrenergic (stress) and cardiovascular responses to incision-MAC BAR. Anesthesiology 1981; 54: 390–8.
von Knobelsdorff G, Kusagaya H, Werner C, Kochs E, am Esch JS. The effects of surgical stimulation on intracranial hemodynamics. J Neurosurg Anesthesiol 1996; 8: 9–14.
Paulson OB, Olesen J, Christensen MS. Restoration of autoregulation of cerebral blood flow by hypocapnia. Neurology 1972; 22: 286–93.
Raichle ME, Stone HL. Cerebral blood flow autoregulation and graded hypercapnia. Eur Neurol 1972; 6: 1–5.
Eisele JH, Eger IIEI, Muallem M. Narcotic properties of carbon dioxide in the dog. Anesthesiology 1967; 28: 856–65.
Zhou HH, Turndorf H. Hyper- and hypoventilation affects spinal motor neuron excitability during isoflurane anesthesia. Anesth Analg 1998; 87: 407–10.
Kastrup A, Li T-Q, Glover GH, Krüger G, Moseley ME. Gender differences in cerebral blood flow and oxygenation response during focal physiologic neural activity. J Cereb Blood Flow Metab 1999; 19: 1066–71.
Author information
Authors and Affiliations
Corresponding author
Additional information
This work was done at the Department of Anesthesiology-Resuscitology, Yamaguchi University School of Medicine.
Rights and permissions
About this article
Cite this article
Kawata, R., Matsumoto, M., Haranishi, Y. et al. Changes in cerebral blood flow velocity elicited by surgical stimulation are dependent on the PaCO2 level. Can J Anaesth 48, 1029–1033 (2001). https://doi.org/10.1007/BF03016596
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03016596