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Impact of stepwise hyperventilation on cerebral tissue oxygen saturation in anesthetized patients: a mechanistic study.

AbstractBACKGROUND:
While the decrease in blood carbon dioxide (CO2 ) secondary to hyperventilation is generally accepted to play a major role in the decrease of cerebral tissue oxygen saturation (SctO2 ), it remains unclear if the associated systemic hemodynamic changes are also accountable.
METHODS:
Twenty-six patients (American Society of Anesthesiologists I-II) undergoing nonneurosurgical procedures were anesthetized with either propofol-remifentanil (n = 13) or sevoflurane (n = 13). During a stable intraoperative period, ventilation was adjusted stepwise from hypoventilation to hyperventilation to achieve a progressive change in end-tidal CO2 (ETCO2 ) from 55 to 25 mmHg. Minute ventilation, SctO2 , ETCO2 , mean arterial pressure (MAP), and cardiac output (CO) were recorded.
RESULTS:
Hyperventilation led to a SctO2 decrease from 78 ± 4% to 69 ± 5% (Δ = -9 ± 4%, P < 0.001) in the propofol-remifentanil group and from 81 ± 5% to 71 ± 7% (Δ = -10 ± 3%, P < 0.001) in the sevoflurane group. The decreases in SctO2 were not statistically different between these two groups (P = 0.5). SctO2 correlated significantly with ETCO2 in both groups (P < 0.001). SctO2 also correlated significantly with MAP (P < 0.001) and CO (P < 0.001) during propofol-remifentanil, but not sevoflurane (P = 0.4 and 0.5), anesthesia.
CONCLUSION:
The main mechanism responsible for the hyperventilation-induced decrease in SctO2 is hypocapnia during both propofol-remifentanil and sevoflurane anesthesia. Hyperventilation-associated increase in MAP and decrease in CO during propofol-remifentanil, but not sevoflurane, anesthesia may also contribute to the decrease in SctO2 but to a much smaller degree.
AuthorsB S Alexander, A W Gelb, W W Mantulin, A E Cerussi, B J Tromberg, Z Yu, C Lee, L Meng
JournalActa anaesthesiologica Scandinavica (Acta Anaesthesiol Scand) Vol. 57 Issue 5 Pg. 604-12 (May 2013) ISSN: 1399-6576 [Electronic] England
PMID23278596 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)
Copyright© 2013 The Acta Anaesthesiologica Scandinavica Foundation.
Chemical References
  • Anesthetics, Inhalation
  • Anesthetics, Intravenous
  • Methyl Ethers
  • Piperidines
  • Carbon Dioxide
  • Sevoflurane
  • Remifentanil
  • Oxygen
  • Propofol
Topics
  • Adult
  • Anesthetics, Inhalation (blood, pharmacology)
  • Anesthetics, Intravenous (blood, pharmacology)
  • Blood Pressure (drug effects)
  • Carbon Dioxide (blood)
  • Cardiac Output (drug effects)
  • Cerebrovascular Circulation
  • Female
  • Humans
  • Hyperventilation (blood, physiopathology)
  • Male
  • Methyl Ethers (blood, pharmacology)
  • Oxygen (blood)
  • Piperidines (blood, pharmacology)
  • Propofol (blood, pharmacology)
  • Remifentanil
  • Sevoflurane

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