The cerebrovascular response to hypocapnia in children receiving propofol.

Anesthesia and Analgesia
Cengiz KarsliBruno Bissonnette

Abstract

Hypocapnia is used to treat acute increases in intracranial pressure during neurosurgery. Cerebrovascular reactivity to carbon dioxide (CCO(2)R) is preserved above 35 mm Hg ETco(2) in children during propofol anesthesia; however, a plateau effect has been suggested below 35 mm Hg. To further delineate this phenomenon, we measured CCO(2)R by transcranial Doppler (TCD) sonography over small increments in ETco(2) in 27 healthy children. Anesthesia comprised a standardized propofol infusion and a caudal epidural block. A TCD probe was placed to measure middle cerebral artery blood flow velocity (V(mca)). ETco(2) was adjusted between 24 and 40 mm Hg at 1-2 mm Hg increments using an exogenous source of CO(2). There was an exponential relationship between ETco(2) and V(mca) above an ETco(2) value of 30 mm Hg (r = 0.82). However, V(mca) did not change with ETco(2) less than 30 mm Hg (r = 0.06). There were no significant changes in heart rate or arterial blood pressure. We conclude that when contemplating methods to decrease brain volume and intracranial pressure, hyperventilation to ETco(2) values less than 30 mm Hg may not be necessary in children receiving propofol, as no further reduction in cerebral blood flow velocity will be achi...Continue Reading

References

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May 7, 2002·British Journal of Anaesthesia·D A RowneyB Bissonnette
Oct 11, 2002·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Cengiz KarsliBruno Bissonnette

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Citations

Mar 27, 2012·Annales Françaises D'anesthèsie Et De Rèanimation·G Orliaguet, UNKNOWN groupe d’experts Sfar-SFMU
Dec 2, 2008·Paediatric Anaesthesia·Elöd Z SzabóBruno Bissonnette
Dec 17, 2009·Acta Anaesthesiologica Scandinavica·L SchlünzenG E Cold
Mar 21, 2006·Current Opinion in Anaesthesiology·Ozan Akça

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