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Changes in cerebral blood flow velocity elicited by surgical stimulation are dependent on the PaCO₂ level

[Les changements de vitesse du flux sanguin cérébral, déclenchés par la stimulation chirurgicale, dépendent du niveau de PaCO₂]

From the Department of Anesthesiology-Resuscitology, Yamaguchi University School of Medicine, Yamaguchi, Japan.

Dr. Ryuichi Kawata, Department of Anesthesiology-Resuscitology, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan. Phone: 836-22-2291; Fax: 836-22-2292; E-mail: sakabe{at}po.cc.yamaguchi-u.ac.jp

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 ( Vmca) with surgical incision during hypercapnia (30–36 cm•sec^–1) was significantly greater than during normocapnia (20–22 cm•sec^–1) and hypocapnia (13–15 cm•sec^–1). The 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.

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				R. Kawata, M. Matsumoto, A. Yamashita, M. Yoshida, S. Matsumoto, Y. Morimoto, and T. Sakabe Nitrous oxide added to propofol does not influence the increase in cerebral blood flow velocity elicited by surgical stimulation Can J Anesth, January 1, 2004; 51(1): 97 - 98. [Full Text]