Regional cerebral blood flow responses to hyperventilation during sevoflurane anaesthesia studied with PET

L Schlünzen, M S Vafaee, N Juul, G E Cold

Research output: Chapter in Book/Report/Conference proceedingBook chapterResearchpeer-review

Abstract

BACKGROUND: Arterial carbon dioxide tension (PaCO(2)) is an important factor controlling cerebral blood flow (CBF) in neurosurgical patients. It is still unclear whether the hypocapnia-induced decrease in CBF is a general effect on the brain or rather linked to specific brain regions. We evaluated the effects of hyperventilation on regional cerebral blood flow (rCBF) in healthy volunteers during sevoflurane anaesthesia measured with positron emission tomography (PET).

METHODS: Eight human volunteers were anaesthetized with sevoflurane 1 MAC, while exposed to hyperventilation. During 1 MAC sevoflurane at normocapnia and 1 MAC sevoflurane at hypocapnia, one H(2)(15)O scan was performed. Statistical parametric maps and conventional regions of interest analysis were used for estimating rCBF differences.

RESULTS: Cardiovascular parameters were maintained constant over time. During hyperventilation, the mean PaCO(2) was decreased from 5.5 + or - 0.7 to 3.8 + or - 0.9 kPa. Total CBF decreased during the hypocapnic state by 44%. PET revealed wide variations in CBF between regions. The greatest values of vascular responses during hypocapnia were observed in the thalamus, medial occipitotemporal gyrus, cerebellum, precuneus, putamen and insula regions. The lowest values were observed in the superior parietal lobe, middle and inferior frontal gyrus, middle and inferior temporal gyrus and precentral gyrus. No increases in rCBF were observed.

CONCLUSIONS: This study reports highly localized and specific changes in rCBF during hyperventilation in sevoflurane anaesthesia, with the most pronounced decreases in the sub cortical grey matter. Such regional heterogeneity of the cerebral vascular response should be considered in the assessment of cerebral perfusion reserve during hypocapnia.

Original languageEnglish
Title of host publicationSpringer
Number of pages6
Volume54
Publication dateMay 2010
Edition5
Pages610-5
DOIs
Publication statusPublished - May 2010
SeriesActa Anaesthesiologica Scandinavica
ISSN0515-2720

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Regional Blood Flow
Hypocapnia
sevoflurane
Putamen
Volunteers
Perfusion

Keywords

  • Adult
  • Anesthetics, Inhalation/administration & dosage
  • Carbon Dioxide/blood
  • Cerebrovascular Circulation/drug effects
  • Dose-Response Relationship, Drug
  • Electroencephalography/drug effects
  • Female
  • Humans
  • Hyperventilation/blood
  • Hypocapnia/blood
  • Male
  • Methyl Ethers/administration & dosage
  • Positron-Emission Tomography
  • Sevoflurane
  • Young Adult

Cite this

Schlünzen, L ; Vafaee, M S ; Juul, N ; Cold, G E. / Regional cerebral blood flow responses to hyperventilation during sevoflurane anaesthesia studied with PET. Springer. Vol. 54 5. ed. 2010. pp. 610-5 (Acta Anaesthesiologica Scandinavica).
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title = "Regional cerebral blood flow responses to hyperventilation during sevoflurane anaesthesia studied with PET",
abstract = "BACKGROUND: Arterial carbon dioxide tension (PaCO(2)) is an important factor controlling cerebral blood flow (CBF) in neurosurgical patients. It is still unclear whether the hypocapnia-induced decrease in CBF is a general effect on the brain or rather linked to specific brain regions. We evaluated the effects of hyperventilation on regional cerebral blood flow (rCBF) in healthy volunteers during sevoflurane anaesthesia measured with positron emission tomography (PET).METHODS: Eight human volunteers were anaesthetized with sevoflurane 1 MAC, while exposed to hyperventilation. During 1 MAC sevoflurane at normocapnia and 1 MAC sevoflurane at hypocapnia, one H(2)(15)O scan was performed. Statistical parametric maps and conventional regions of interest analysis were used for estimating rCBF differences.RESULTS: Cardiovascular parameters were maintained constant over time. During hyperventilation, the mean PaCO(2) was decreased from 5.5 + or - 0.7 to 3.8 + or - 0.9 kPa. Total CBF decreased during the hypocapnic state by 44{\%}. PET revealed wide variations in CBF between regions. The greatest values of vascular responses during hypocapnia were observed in the thalamus, medial occipitotemporal gyrus, cerebellum, precuneus, putamen and insula regions. The lowest values were observed in the superior parietal lobe, middle and inferior frontal gyrus, middle and inferior temporal gyrus and precentral gyrus. No increases in rCBF were observed.CONCLUSIONS: This study reports highly localized and specific changes in rCBF during hyperventilation in sevoflurane anaesthesia, with the most pronounced decreases in the sub cortical grey matter. Such regional heterogeneity of the cerebral vascular response should be considered in the assessment of cerebral perfusion reserve during hypocapnia.",
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author = "L Schl{\"u}nzen and Vafaee, {M S} and N Juul and Cold, {G E}",
year = "2010",
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Regional cerebral blood flow responses to hyperventilation during sevoflurane anaesthesia studied with PET. / Schlünzen, L; Vafaee, M S; Juul, N; Cold, G E.

Springer. Vol. 54 5. ed. 2010. p. 610-5 (Acta Anaesthesiologica Scandinavica).

Research output: Chapter in Book/Report/Conference proceedingBook chapterResearchpeer-review

TY - CHAP

T1 - Regional cerebral blood flow responses to hyperventilation during sevoflurane anaesthesia studied with PET

AU - Schlünzen, L

AU - Vafaee, M S

AU - Juul, N

AU - Cold, G E

PY - 2010/5

Y1 - 2010/5

N2 - BACKGROUND: Arterial carbon dioxide tension (PaCO(2)) is an important factor controlling cerebral blood flow (CBF) in neurosurgical patients. It is still unclear whether the hypocapnia-induced decrease in CBF is a general effect on the brain or rather linked to specific brain regions. We evaluated the effects of hyperventilation on regional cerebral blood flow (rCBF) in healthy volunteers during sevoflurane anaesthesia measured with positron emission tomography (PET).METHODS: Eight human volunteers were anaesthetized with sevoflurane 1 MAC, while exposed to hyperventilation. During 1 MAC sevoflurane at normocapnia and 1 MAC sevoflurane at hypocapnia, one H(2)(15)O scan was performed. Statistical parametric maps and conventional regions of interest analysis were used for estimating rCBF differences.RESULTS: Cardiovascular parameters were maintained constant over time. During hyperventilation, the mean PaCO(2) was decreased from 5.5 + or - 0.7 to 3.8 + or - 0.9 kPa. Total CBF decreased during the hypocapnic state by 44%. PET revealed wide variations in CBF between regions. The greatest values of vascular responses during hypocapnia were observed in the thalamus, medial occipitotemporal gyrus, cerebellum, precuneus, putamen and insula regions. The lowest values were observed in the superior parietal lobe, middle and inferior frontal gyrus, middle and inferior temporal gyrus and precentral gyrus. No increases in rCBF were observed.CONCLUSIONS: This study reports highly localized and specific changes in rCBF during hyperventilation in sevoflurane anaesthesia, with the most pronounced decreases in the sub cortical grey matter. Such regional heterogeneity of the cerebral vascular response should be considered in the assessment of cerebral perfusion reserve during hypocapnia.

AB - BACKGROUND: Arterial carbon dioxide tension (PaCO(2)) is an important factor controlling cerebral blood flow (CBF) in neurosurgical patients. It is still unclear whether the hypocapnia-induced decrease in CBF is a general effect on the brain or rather linked to specific brain regions. We evaluated the effects of hyperventilation on regional cerebral blood flow (rCBF) in healthy volunteers during sevoflurane anaesthesia measured with positron emission tomography (PET).METHODS: Eight human volunteers were anaesthetized with sevoflurane 1 MAC, while exposed to hyperventilation. During 1 MAC sevoflurane at normocapnia and 1 MAC sevoflurane at hypocapnia, one H(2)(15)O scan was performed. Statistical parametric maps and conventional regions of interest analysis were used for estimating rCBF differences.RESULTS: Cardiovascular parameters were maintained constant over time. During hyperventilation, the mean PaCO(2) was decreased from 5.5 + or - 0.7 to 3.8 + or - 0.9 kPa. Total CBF decreased during the hypocapnic state by 44%. PET revealed wide variations in CBF between regions. The greatest values of vascular responses during hypocapnia were observed in the thalamus, medial occipitotemporal gyrus, cerebellum, precuneus, putamen and insula regions. The lowest values were observed in the superior parietal lobe, middle and inferior frontal gyrus, middle and inferior temporal gyrus and precentral gyrus. No increases in rCBF were observed.CONCLUSIONS: This study reports highly localized and specific changes in rCBF during hyperventilation in sevoflurane anaesthesia, with the most pronounced decreases in the sub cortical grey matter. Such regional heterogeneity of the cerebral vascular response should be considered in the assessment of cerebral perfusion reserve during hypocapnia.

KW - Adult

KW - Anesthetics, Inhalation/administration & dosage

KW - Carbon Dioxide/blood

KW - Cerebrovascular Circulation/drug effects

KW - Dose-Response Relationship, Drug

KW - Electroencephalography/drug effects

KW - Female

KW - Humans

KW - Hyperventilation/blood

KW - Hypocapnia/blood

KW - Male

KW - Methyl Ethers/administration & dosage

KW - Positron-Emission Tomography

KW - Sevoflurane

KW - Young Adult

U2 - 10.1111/j.1399-6576.2009.02181.x

DO - 10.1111/j.1399-6576.2009.02181.x

M3 - Book chapter

VL - 54

SP - 610

EP - 615

BT - Springer

ER -