open access

Vol 45, No 4 (2013 Oct-Dec)
Original and clinical articles
Submitted: 2014-01-06
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Effect of sevoflurane on cerebral perfusion pressure in patients with internal hydrocephalus

Zbigniew Karwacki, Małgorzata Witkowska, Seweryn Niewiadomski, Andrzej Wiatr, Jarosław Dzierżanowski, Paweł Słoniewski
DOI: 10.5603/AIT.2013.0041
·
Anaesthesiol Intensive Ther 2013;45(4):211-214.

open access

Vol 45, No 4 (2013 Oct-Dec)
Original and clinical articles
Submitted: 2014-01-06

Abstract

BACKGROUND: Due to its confirmed neuroprotective properties, sevoflurane is one of a few anaesthetics used for neuroanaesthesia. Its effects on the cerebral and systemic circulations may be of particular importance in patientswith intracranial pathology. This study aimed to evaluate the effect of sevoflurane at concentrations lower than 1 MAC on cerebral perfusion pressure (CPP) in patients with internal hydrocephalus.

METHODS: The study was conducted on14 patients with internal hydrocephalus, who underwent ventriculo-peritoneal shunt implantation. After inserting the catheter into the lateral cerebral ventricle, sevoflurane, at 1.1 and 2.2 vol%, was initiated at two successive 15-minute intervals. The intracranial pressure (ICP) was continuously measured; special attention was focused on the values prior to and at the end of each observation period. The following parameters were monitored: mean arterial pressure (MAP), CPP, heart rate, end-tidal CO2 concentration, core body temperature, and the inspiratory and end-expiratory concentrations of sevoflurane.

RESULTS: The HR and MAP decreased during successive observation intervals compared to baseline values. Likewise, the CPP decreased from 75.6 ± 2.8 mm Hg to 72.2 ± 2.6 mm Hg to 70.2 ± 0.8 mm Hg. The baseline value for ICP was 16.3 ± 0.6 mm Hg and increased to 17.7 ± 0.8 and 18.9 ± 0.5 mm Hg during the next observation periods.

CONCLUSIONS: Sevoflurane administered ata concentration below 1MAC to patients with internal hydrocephalus increases the ICP and decreases the MAP, which leads to adecrease in CPP. The CPP decrease is more dependent on depressing the systemic circulatory system than an increased ICP.

Abstract

BACKGROUND: Due to its confirmed neuroprotective properties, sevoflurane is one of a few anaesthetics used for neuroanaesthesia. Its effects on the cerebral and systemic circulations may be of particular importance in patientswith intracranial pathology. This study aimed to evaluate the effect of sevoflurane at concentrations lower than 1 MAC on cerebral perfusion pressure (CPP) in patients with internal hydrocephalus.

METHODS: The study was conducted on14 patients with internal hydrocephalus, who underwent ventriculo-peritoneal shunt implantation. After inserting the catheter into the lateral cerebral ventricle, sevoflurane, at 1.1 and 2.2 vol%, was initiated at two successive 15-minute intervals. The intracranial pressure (ICP) was continuously measured; special attention was focused on the values prior to and at the end of each observation period. The following parameters were monitored: mean arterial pressure (MAP), CPP, heart rate, end-tidal CO2 concentration, core body temperature, and the inspiratory and end-expiratory concentrations of sevoflurane.

RESULTS: The HR and MAP decreased during successive observation intervals compared to baseline values. Likewise, the CPP decreased from 75.6 ± 2.8 mm Hg to 72.2 ± 2.6 mm Hg to 70.2 ± 0.8 mm Hg. The baseline value for ICP was 16.3 ± 0.6 mm Hg and increased to 17.7 ± 0.8 and 18.9 ± 0.5 mm Hg during the next observation periods.

CONCLUSIONS: Sevoflurane administered ata concentration below 1MAC to patients with internal hydrocephalus increases the ICP and decreases the MAP, which leads to adecrease in CPP. The CPP decrease is more dependent on depressing the systemic circulatory system than an increased ICP.

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Keywords

volatile anaesthetics, sevoflurane; intracranial pressure; cerebral perfusion pressure; internal hydrocephalus

About this article
Title

Effect of sevoflurane on cerebral perfusion pressure in patients with internal hydrocephalus

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 45, No 4 (2013 Oct-Dec)

Pages

211-214

DOI

10.5603/AIT.2013.0041

Bibliographic record

Anaesthesiol Intensive Ther 2013;45(4):211-214.

Keywords

volatile anaesthetics
sevoflurane
intracranial pressure
cerebral perfusion pressure
internal hydrocephalus

Authors

Zbigniew Karwacki
Małgorzata Witkowska
Seweryn Niewiadomski
Andrzej Wiatr
Jarosław Dzierżanowski
Paweł Słoniewski

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