Abstract
Purpose
This study investigates the effects of S(+)-ketamine and propofol in comparison to sevoflurane on dynamic cerebrovascular autoregulation in humans.
Methods
Twenty-four patients were randomly assigned to one of the following anesthetic protocols: group I (n = 12): 2.5 mg·kg−1·hr−1 S(+)-ketamine, 1.5–2.5 μg·mL−1 propofol-target plasma concentration; group II (n = 12): 2.0 MAC (4.0 %) sevoflurane. Patients were intubated and ventilated with O2/air (PaO2=0.33). Following 40 min of equilibration dynamic cerebrovascular autoregulation was measured and expressed as the autoregulatory index (ARI), describing the duration of cerebral hemodynamic recovery in relation to changes in mean arterial blood pressure. Statistics: Mann-Whitney U test (statistical significance was assumed whenP < 0.05).
Results
Dynamic cerebrovascular autoregulation was intact in all patients with S(+)-ketamine/propofol anesthesia as indicated by an ARJ of 5.4 ± 1.1. In contrast, dynamic cerebrovascular autoregulation was significantly delayed with 2.0 MAC sevoflurane (ARI =2.6 ± 0.7).
Conclusion
Dynamic cerebrovascular autoregulation is maintained with S(+)-ketamine/propofol-based totaliv anesthesia. In contrast, 2.0 MAC sevoflurane delayed dynamic cerebrovascular autoregulation. This supports the use of S(+)-ketamine in combination with propofol in neurosurgical patients based on its neuroprotective potential along with maintained cerebrovascular physiology.
Résumé
Objectif
Examiner les effets de la S(+)kétamlne et du propofol, comparés au sévoflurane, sur l’autorégulatlon vasculalre cérébrale dynamique chez l’humain.
Méthode
Vingt-quatre patients ont été répartis au hasard et ont reçu un des protocoles anesthéslques suivants: groupe I (n = 12): 2,5 mg·kg−1· h−1 de S(+)kétamlne, une concentration plasmatlque cible de propofol de 1,5-2,5μg·mL−1; groupe II (n = 12): 2,0 CAM (4,0 %) de sévoflurane. On a procédé à l’intubation et à la ventilation avec un mélange de O2/alr (PaO2 = 0,33). Après un temps d’équilibre de 40 min, l’autorégulatlon vasculalre cérébrale a été mesurée et exprimée comme l’indice d’autorégulation (IAR), décrivant la durée de la récupération hémodynamique cérébrale en relation avec les modifications de la tension artérielle moyenne. Données statistiques: test U de Mann-Whitney (signification statistique avec P < 0,05).
Résultats
L’autorégulatlon vasculalre cérébrale dynamique était Intacte chez tous les patients sous anesthésle avec S(+)kétamlne/propofol comme l’indiquait un IAR de 5,4 ± 1,1. Par ailleurs, elle a été significativement retardée avec les 2,0 CAM de sévoflurane (IAR = 2,6 ± 0,7).
Conclusion
L’autorégulation vasculalre cérébrale dynamique est maintenue avec une anesthésle exclusivement intraveineuse à base de S(+)kétamlne/propofol mais retardée avec 2,0 CAM de sévoflurane. Ces données favorisent l’usage de S(+)kétamlne combinée au propofol, en neurochirurgie, usage fondé sur leur potentiel de neuroprotection et de maintien de la physiologie vasculalre cérébrale.
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Engelhard, K., Werner, C., Möllenberg, O. et al. S(+)-ketamine/propofol maintain dynamic cerebrovascular autoregulation in humans. Can J Anaesth 48, 1034–1039 (2001). https://doi.org/10.1007/BF03016597
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DOI: https://doi.org/10.1007/BF03016597