Abstract SNACC-83

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Effect of propofol, sevoflurane and desflurane on regional cerebral blood flow measured by near infrared spectroscopy

1Kubota Y, 1Yoshitani K, 1ohnishi Y, 2Inatomi Y, 1Katou S
1National Cerebral and Cardiovascular Center, suitashi, Oosakahu, Japan; 2national Cerebral and Cardiovascular Center, suitashi, Oosakahu, Japan

Background
The effect of anesthetic agents on cerebral blood flow is clinically crucial in neuro anesthesia. Desflurane and sevoflurane are dose-dependent cerebral vasodilators . Desflurane has been shown to increase cerebral blood flow (CBF) and deemed to be a more potent cerebral vasodilator than other volatile agents . On the other hand, Propofol has been shown to decrease CBF . However those data were collected almost in animals or surrogate parameters, cerebral blood flow velocity. In human, very few previous reports measured CBF directly using argon gas in the operating room due to lack of the convenient methodology of direct measurement of CBF in bedside. Recently NIRO-200NX (Hamatsu Photonix, Hamamatsu, Japan), near infrared spectroscopy device, enables to measure regional cerebral blood flow as blood flow index (BFI) in the operating room. Therefore, we conducted a study to evaluate the effect of propofol, sevoflurane and desflurane on CBF in human during anesthesia using BFI.
Method
After approval of institutional ethical board, patients undergoing elective endvascular aneurysm repair (EVAR) for abdominal aortic aneurysm were enrolled in this study. The reason why we selected those patients was that surgical noxious stimulus are minimum during EVAR after cannulation of vessel sheath into femoral arteries, Therefore hemodynamic condition was stable, suggesting anesthetic depth may be controllable. After induction of general anesthesia, NIRS sensor was placed bilaterally 1cm above eyebrow on the scalp. The dye indocyanine green (0.5 mg/kg) was injected via internal jugular vein following three times. 1: Thirty minutes after the induction of general anesthesia when propofol was used for maintenance of anesthesia. 2: Thirty minutes after changing anesthetic agent to sevoflurane or desflurane. 3: Thirty minutes after changing anesthetic agent to the other one (desflurane or sevoflurane). We kept bispectal index (BIS) from 40 to 60 for keeping anesthetic depth stable among three anesthetic agents. The kinetics of an intravenous bolus of indocyanine green was monitored by NIRO 200NX. BFI was calculated using slope of the concentration of indocyanine green by computer software, NIRO ICG, supplied by Hamamatsu Photonics. Simultaneously mean arterial blood pressure (MAP), PO2, PCO2, and BIS value were recorded. To validate BFI, we also measure cerebral blood flow velocity using Doppler flow meter in carotid artery.
Results
There was no significant difference in BIS, PaCO2, MAP among the three anesthetic agents. (Table1) Percent change of CVFB, BFI, TOI (rSO2) showed no significant difference among the three groups. (Figure1-3)
Conclusion
Unlike previous animal and human studies, there was no significant difference in regional CBF and CBFV among the three anesthetic agents.

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