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KMID : 0356920090560050543
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Korean Journal of Anesthesiology
2009 Volume.56 No. 5 p.543 ~ p.551
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Response of cerebral oximetry to increase in alveolar concentration of desflurane: effect of remifentanil and cerebrovascular CO2 reactivity
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Lee Jeoung-Hyuk
Lee Youn-Suk
In Jun-Yong
Chung Seung-Hyun
Shin Hong-il
Lee Kyoung-Jin
Kim Kyoung-Ok
Cho Hun
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Abstract
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Background: It is known that sympathetic stimulation and increase in cerebral blood flow velocity can be induced by desflurane. Cerebral oxygen balance could be disturbed during desflurane induction. Aim of this study was to elucidate that cerebral oxygen imbalance induced by desflurane mask induction can be reduced by combination of remifentanil and hypocapnia.
Methods: Twenty ASA 1-2 subjects were allocated randomly into 5 groups divided by concentration of remifentanil (0.0, 0.5, 1.0, 1.5, and 2.0 ng/ml). After confirmation of attaining proposed concentration of remifentanil, propofol and vecuronium were administered and mechanical ventilation was done with 8% desflurane with facial mask. Subsequently, changes in regional cerebral oxygen saturation (?rSO2), arterial blood pressure, heart rate, cardiac index, estimated alveolar concentration of desflurane (PDESF), and end-tidal concentration of carbon dioxide (PETCO2) were recorded for the following 10 minutes. According to concentration of desflurane and remifentanil, ?rSO2 and hemodynamic factors were checked.
Results: During desflurane induction, changes in cerebral oximetry reached up to ＋10% (6 [first quartile], 13 [third quartile]). Arterial blood pressure, heart rate, and cardiac index were changed within clinical ranges. The ?rSO2 showed S-shaped increasing pattern according to increasing PDESF. Hypocapnia and concentration of remifentanil reduced the maximum ?rSO2 (P = 0.0046, P = 0.0060). Hypocapnia also shifted the curve to left (P = 0.0001).
Conclusions: During 8% desflurane induction, regional cerebral oxygen saturation (rSO2) increases maximum ＋25%. Hypocapnia and use of remifentanil can reduce the increase in regional cerebral oxygen saturation.
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KEYWORD
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Cerebral blood flow, Cerebral oximetry, Desflurane, Hypocapnia, Nonlinear mixed model, Remifentanil
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