Evaluation of Cerebrovascular Carbon Dioxide Reactivity in Patients with Diabetes Mellitus Under Sedative Doses of Propofol

Overview

Journal J Anesth

Specialty Anesthesiology

Date 2008 Nov 18

PMID 19011782

Authors

Chikara Kawauchi

Yuji Kadoi

Hiroshi Hinohara

Fumio Kunimoto

Shigeru Saito

Affiliations

Soon will be listed here.

Abstract

The present study compared cerebrovascular CO2 reactivity in diabetic patients on different treatment modalities under sedative doses of propofol. Fifteen patients with diabetes mellitus (on three different antidiabetic treatment modalities) who required mechanical ventilation during intensive care therapy were studied, sedation during mechanical ventilation being maintained using propofol. As controls, 6 patients without diabetes were monitored. A 2.5-MHz pulsed transcranial Doppler probe was attached to the head of the patient at the right temporal window for continuous measurement of mean blood flow velocity in the middle cerebral artery (Vmca). After establishing baseline values of Vmca and cardiovascular hemodynamics, end-tidal CO2 was decreased by increasing ventilatory frequency by 5-8 breaths.min(-1). Values for absolute and relative CO2 reactivity in insulintreated patients were lower than those in the other three groups (absolute CO2 reactivity [means +/- SD]: control, 3.1 +/- 0.6 cm.s(-1).mmHg(-1), diet, 3.8 +/- 1.4 cm.s(-1) x mmHg(-1); oral antidiabetic drug 3.2 +/- 0.9 cm x s(-1) x mmHg(-1); insulin, 1.1 +/- 0.6 cm x s(-1) x mmHg(-1); P = 0.002).The present study shows that insulin-treated diabetic patients probably have lower cerebrovascular CO2 reactivity under propofol anesthesia than control patients or diabetics treated with dietary therapy or oral hypoglycemics.

References

Steiner L, Johnston A, Chatfield D, Czosnyka M, Coleman M, Coles J . The effects of large-dose propofol on cerebrovascular pressure autoregulation in head-injured patients. Anesth Analg. 2003; 97(2):572-576. DOI: 10.1213/01.ANE.0000070234.17226.B0. View

Kadoi Y, Saito S, Takahashi K . The comparative effects of sevoflurane vs. isoflurane on cerebrovascular carbon dioxide reactivity in patients with hypertension. Acta Anaesthesiol Scand. 2007; 51(10):1382-7. DOI: 10.1111/j.1399-6576.2007.01422.x. View

Conti A, Iacopino D, Fodale V, Micalizzi S, Penna O, Santamaria L . Cerebral haemodynamic changes during propofol-remifentanil or sevoflurane anaesthesia: transcranial Doppler study under bispectral index monitoring. Br J Anaesth. 2006; 97(3):333-9. DOI: 10.1093/bja/ael169. View

Strebel S, Kindler C, Bissonnette B, Tschaler G, Deanovic D . The impact of systemic vasoconstrictors on the cerebral circulation of anesthetized patients. Anesthesiology. 1998; 89(1):67-72. DOI: 10.1097/00000542-199807000-00012. View

Kadoi Y, Hinohara H, Kunimoto F, Saito S, Ide M, Hiraoka H . Diabetic patients have an impaired cerebral vasodilatory response to hypercapnia under propofol anesthesia. Stroke. 2003; 34(10):2399-403. DOI: 10.1161/01.STR.0000090471.28672.65. View

Kadoi Y, Ide M, Saito S, Shiga T, Ishizaki K, Goto F . Hyperventilation after tourniquet deflation prevents an increase in cerebral blood flow velocity. Can J Anaesth. 1999; 46(3):259-64. DOI: 10.1007/BF03012606. View

Myburgh J, Upton R, Grant C, Martinez A . Epinephrine, norepinephrine and dopamine infusions decrease propofol concentrations during continuous propofol infusion in an ovine model. Intensive Care Med. 2001; 27(1):276-82. DOI: 10.1007/s001340000793. View

Soliman H, Melot C, Vincent J . Sedative and analgesic practice in the intensive care unit: the results of a European survey. Br J Anaesth. 2001; 87(2):186-92. DOI: 10.1093/bja/87.2.186. View

Myburgh J, Upton R, Ludbrook G, Martinez A, Grant C . Cerebrovascular carbon dioxide reactivity in sheep: effect of propofol or isoflurane anaesthesia. Anaesth Intensive Care. 2002; 30(4):413-21. DOI: 10.1177/0310057X0203000402. View

10.

Fodale V, Schifilliti D, Conti A, Lucanto T, Pino G, Santamaria L . Transcranial Doppler and anesthetics. Acta Anaesthesiol Scand. 2007; 51(7):839-47. DOI: 10.1111/j.1399-6576.2007.01355.x. View

11.

Kadoi Y, Hinohara H, Kunimoto F, Saito S, Goto F . Fentanyl-induced hemodynamic changes after esophagectomy or cardiac surgery. J Clin Anesth. 2006; 17(8):598-603. DOI: 10.1016/j.jclinane.2005.04.004. View

12.

Moppett I, Mahajan R . Transcranial Doppler ultrasonography in anaesthesia and intensive care. Br J Anaesth. 2004; 93(5):710-24. DOI: 10.1093/bja/aeh205. View

13.

Jacobi J, Fraser G, Coursin D, Riker R, Fontaine D, Wittbrodt E . Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med. 2002; 30(1):119-41. DOI: 10.1097/00003246-200201000-00020. View

14.

McCulloch T, Visco E, Lam A . Graded hypercapnia and cerebral autoregulation during sevoflurane or propofol anesthesia. Anesthesiology. 2000; 93(5):1205-9. DOI: 10.1097/00000542-200011000-00012. View

15.

Kadoi Y, Saito S, Kawauchi C, Hinohara H, Kunimoto F . Comparative effects of propofol vs dexmedetomidine on cerebrovascular carbon dioxide reactivity in patients with septic shock. Br J Anaesth. 2008; 100(2):224-9. DOI: 10.1093/bja/aem343. View

16.

Eng C, Lam A, Mayberg T, Lee C, Mathisen T . The influence of propofol with and without nitrous oxide on cerebral blood flow velocity and CO2 reactivity in humans. Anesthesiology. 1992; 77(5):872-9. DOI: 10.1097/00000542-199211000-00006. View

17.

Turina M, Christ-Crain M, Polk Jr H . Diabetes and hyperglycemia: strict glycemic control. Crit Care Med. 2006; 34(9 Suppl):S291-300. DOI: 10.1097/01.CCM.0000231887.84751.04. View

18.

Harrison J, Girling K, Mahajan R . Effects of target-controlled infusion of propofol on the transient hyperaemic response and carbon dioxide reactivity in the middle cerebral artery. Br J Anaesth. 2000; 83(6):839-44. DOI: 10.1093/bja/83.6.839. View

19.

Hinohara H, Kadoi Y, Takahashi K, Saito S, Goto F . Cerebrovascular carbon dioxide reactivity with propofol anesthesia in patients with previous stroke. J Clin Anesth. 2004; 16(7):483-7. DOI: 10.1016/j.jclinane.2003.11.001. View

20.

Moppett I, Wild M, Sherman R, Latter J, Miller K, Mahajan R . Effects of ephedrine, dobutamine and dopexamine on cerebral haemodynamics: transcranial Doppler studies in healthy volunteers. Br J Anaesth. 2003; 92(1):39-44. DOI: 10.1093/bja/aeh014. View