PMID: 8592968Dec 1, 1995Paper

Effects of analgesia and sedation on cerebrovascular circulation, cerebral blood volume, cerebral metabolism and intracranial pressure

Der Anaesthesist
C Werner

Abstract

Cerebral blood flow autoregulation, CO2 reactivity and the pressure-volume relationship may be impaired or abolished in patients with intracranial mass lesions, brain trauma, cerebral vasospasm or increased cerebral elastance. Sedatives, analgetics, and anesthetics may induce major changes in cerebral blood flow, cerebral metabolism and intracranial pressure (ICP). The inadequate use of these drugs may aggravate the preexisting intracranial pathology and may worsen outcome. Thus it is important to understand the effects of sedatives, analgetics, and anaesthetics on intracranial hemodynamics and metabolism during physiological and pathological conditions. Hypnotics (barbiturates, etomidate, propofol), benzodiazepines, opioids (fentanyl, alfentanil, sufentanil) and alpha-2-adrenergic agonists (clonidine, dexmedetomidine) reduce cerebral blood flow. With ketamine, cerebral blood flow changes in a regionally specific fashion, with some territories showing increases and others showing decreases in cerebral blood flow. Cerebral metabolism is decreased during sedation and analgesia with hypnotics, benzodiazepines, and opioids, while infusion of ketamine produces stimulation as well as suppression of cerebral metabolism. This suggests ...Continue Reading

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