Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.04.002
Brazilian Journal of Anesthesiology
Clinical Research

The effect of propofol-sufentanil intravenous anesthesia on systemic and cerebral circulation, cerebral autoregulation and CO2 reactivity – a case-series

O efeito da anestesia intravenosa com propofol-sufentanil na circulação sistêmica e cerebral, autorregulação cerebral e reatividade ao CO2 : uma série de casos

Marianna Juhász, Dénes Páll, Béla Fülesdi, Levente Molnár, Tamás Végh, Csilla Molnár

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Abstract

Background and objectives
The aim of our study was to assess systemic and cerebral hemodynamic changes as well as cerebral CO2-reactivity during propofol anesthesia.

Methods
27 patients undergoing general anesthesia were enrolled. Anesthesia was maintained using the Target-Controlled Infusion (TCI) method according to the Schnider model, effect site propofol concentration of 4 μg.mL-1. Ventilatory settings (respiratory rate and tidal volume) were adjusted to reach and maintain 40, 35 and 30 mmHg EtCO2 for 5-minutes, respectively. At the end of each period, transcranial Doppler and hemodynamic parameters using applanation tonometry were recorded.

Results
Systemic mean arterial pressure significantly decreased during anesthetic induction and remained unchanged during the entire study period. Central aortic and peripherial pulse pressure did not change significantly during anesthetic induction and maintenance, whereas augmentation index as marker of arterial stiffness significantly decreased during the anesthetic induction and remained stable at the time points when target CO2 levels were reached. Both cerebral autoregulation and cerebral CO2-reactivity was maintained during propofol anesthesia.

Conclusions
Propofol at clinically administered doses using the Total Intravenous Anesthesia (TIVA/TCI) technique decreases systemic blood pressure, but does not affect static cerebral autoregulation, flow-metabolism coupling and cerebrovascular CO2 reactivity. According to our measurements, propofol may exert its systemic hemodynamic effect through venodilation.

Trial registration
The study was registered at http://www.clinicaltrials.gov, identifier: NCT02203097, registration date: July 29, 2014.

Keywords

Propofol,  Cerebral blood flow,  Cerebral autoregulation,  CO2-reactivity,  Applanation tonometry,  Transcranial Doppler

Resumo

Justificativa e objetivos: O objetivo do nosso estudo foi avaliar as alterações hemodinâmicas sistêmicas e cerebrais, bem como a reatividade cerebral de CO2 durante a anestesia com propofol. Métodos: 27 pacientes submetidos à anestesia geral foram incluídos. A manutenção da anestesia foi realizada pelo método de Infusão Controlada-Alvo (TCI) de acordo com o modelo Schnider, concentração de propofol no local de efeito de 4 g.mL-1. As configurações ventilatórias (frequência respiratória e volume corrente) foram ajustadas para atingir e manter 40, 35 e 30 mmHg de EtCO2 por 5 minutos, respectivamente. Ao final de cada período, o Doppler transcraniano e os parâmetros hemodinâmicos por meio da tonometria de aplanação foram registrados. Resultados: A pressão arterial média sistêmica diminuiu significativamente durante a indução anestésica e permaneceu inalterada durante todo o período do estudo. A pressão de pulso aórtica central e periférica não mudou significativamente durante a indução e manutenção anestésica, enquanto o índice de aumento como marcador de rigidez arterial diminuiu significativamente durante a indução anestésica e permaneceu estável nos momentos em que os níveis-alvo de CO2 foram atingidos. Tanto a autorregulação cerebral quanto a reatividade cerebral de CO2 foram mantidas durante a anestesia com propofol. Conclusões: O propofol em doses administradas clinicamente pela técnica de anestesia intravenosa total (TIVA / TCI) diminui a pressão arterial sistêmica, mas não afeta a autorregulação cerebral estática, o acoplamento do metabolismo do fluxo e a reatividade cerebrovascular de CO2. De acordo com nossas medições, o propofol pode exercer seu efeito hemodinâmico sistêmico por meio da venodilatação.

Palavras-chave

Propofol; Fluxo de sangue cerebral; Autorregulação cerebral; Reatividade de CO2; Tonometria de aplanação; Doppler transcraniano

References

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