Effect of Dexmedetomidine on Dynamic Cerebral Autoregulation and Carbon Dioxide Reactivity During Sevoflurane Anesthesia in Healthy Patients

Overview

Journal Korean J Anesthesiol

Specialty Anesthesiology

Date 2020 Mar 27

PMID 32209963

Citations 3

Authors

Sujoy Banik

Girija Prasad Rath

Ritesh Lamsal

Parmod K Bithal

Affiliations

Soon will be listed here.

Abstract

Background: There are conflicting opinions on the effect of dexmedetomidine on cerebral autoregulation. This study assessed its effect on dynamic cerebral autoregulation (dCA) using a transcranial Doppler (TCD).

Methods: Thirty American Society of Anesthesiologists physical status I and II patients between 18 and 60 years, who underwent lumbar spine surgery, received infusions of dexmedetomidine (Group D) or normal saline (Group C), followed by anesthesia with propofol and fentanyl, and maintenance with oxygen, nitrous oxide and sevoflurane. After five minutes of normocapnic ventilation and stable bispectral index value (BIS) of 40-50, the right middle cerebral artery flow velocity (MCAFV) was recorded with TCD. The transient hyperemic response (THR) test was performed by compressing the right common carotid artery for 5-7 seconds. The lungs were hyperventilated to test carbon dioxide (CO2) reactivity. Hemodynamic parameters, arterial CO2 tension, pulse oximetry (SpO2), MCAFV and BIS were measured before and after hyperventilation. Dexmedetomidine infusion was discontinued ten minutes before skin-closure. Time to recovery and extubation, modified Aldrete score, and emergence agitation were recorded.

Results: Demographic parameters, durations of surgery and anesthesia, THR ratio (Group D: 1.26 ± 0.11 vs. Group C: 1.23 ± 0.04; P = 0.357), relative CO2 reactivity (Group D: 1.19 ± 0.34 %/mmHg vs. Group C: 1.23 ± 0.25 %/mmHg; P = 0.547), blood pressure, SpO2, BIS, MCAFV, time to recovery, time to extubation and modified Aldrete scores were comparable.

Conclusions: Dexmedetomidine administration does not impair dCA and CO2 reactivity in patients undergoing spine surgery under sevoflurane anesthesia.

Citing Articles

Objective Assessment of Perioperative Anxiety using Functional Near-infrared Spectroscopy in Elderly Patients: A Prospective Randomized Observational Pilot Study.

Kim H, Lee D, Ri H, Choi J, Choi J, Rhee S Int J Med Sci. 2023; 20(13):1763-1773.

PMID: 37928873 PMC: 10620860. DOI: 10.7150/ijms.89287.

Tale of Two Cities: narrative review of oxygen.

Gullapalli P, Fossati N, Stamenkovic D, Haque M, Cattano D F1000Res. 2023; 12:246.

PMID: 37224313 PMC: 10189297. DOI: 10.12688/f1000research.130592.2.

Transparency considerations for describing statistical analyses in research.

Kwak S, Kim J Korean J Anesthesiol. 2021; 74(6):488-495.

PMID: 34784456 PMC: 8648514. DOI: 10.4097/kja.21203.

References

Ainslie P, Celi L, McGrattan K, Peebles K, Ogoh S . Dynamic cerebral autoregulation and baroreflex sensitivity during modest and severe step changes in arterial PCO2. Brain Res. 2008; 1230:115-24. DOI: 10.1016/j.brainres.2008.07.048. View

Grathwohl K, Black I, Spinella P, Sweeney J, Robalino J, Helminiak J . Total intravenous anesthesia including ketamine versus volatile gas anesthesia for combat-related operative traumatic brain injury. Anesthesiology. 2008; 109(1):44-53. DOI: 10.1097/ALN.0b013e31817c02e3. View

Rozet I, Vavilala M, Lindley A, Visco E, Treggiari M, Lam A . Cerebral autoregulation and CO2 reactivity in anterior and posterior cerebral circulation during sevoflurane anesthesia. Anesth Analg. 2006; 102(2):560-4. DOI: 10.1213/01.ane.0000184817.10595.62. View

Gupta S, Heath K, Matta B . Effect of incremental doses of sevoflurane on cerebral pressure autoregulation in humans. Br J Anaesth. 1997; 79(4):469-72. DOI: 10.1093/bja/79.4.469. View

Giller C . A bedside test for cerebral autoregulation using transcranial Doppler ultrasound. Acta Neurochir (Wien). 1991; 108(1-2):7-14. DOI: 10.1007/BF01407660. View

Ogawa Y, Iwasaki K, Shibata S, Kato J, Ogawa S, Oi Y . The effect of sevoflurane on dynamic cerebral blood flow autoregulation assessed by spectral and transfer function analysis. Anesth Analg. 2006; 102(2):552-9. DOI: 10.1213/01.ane.0000189056.96273.48. View

Drummond J, Dao A, Roth D, Cheng C, Atwater B, Minokadeh A . Effect of dexmedetomidine on cerebral blood flow velocity, cerebral metabolic rate, and carbon dioxide response in normal humans. Anesthesiology. 2008; 108(2):225-32. DOI: 10.1097/01.anes.0000299576.00302.4c. View

Aaslid R, Lindegaard K, Sorteberg W, Nornes H . Cerebral autoregulation dynamics in humans. Stroke. 1989; 20(1):45-52. DOI: 10.1161/01.str.20.1.45. View

Dagal A, Lam A . Cerebral autoregulation and anesthesia. Curr Opin Anaesthesiol. 2009; 22(5):547-52. DOI: 10.1097/ACO.0b013e32833020be. View

10.

Smielewski P, Czosnyka M, Kirkpatrick P, Pickard J . Evaluation of the transient hyperemic response test in head-injured patients. J Neurosurg. 1997; 86(5):773-8. DOI: 10.3171/jns.1997.86.5.0773. View

11.

Karwacki Z, Niewiadomski S, Rzaska M, Witkowska M . The effect of bispectral index monitoring on anaesthetic requirements in target-controlled infusion for lumbar microdiscectomy. Anaesthesiol Intensive Ther. 2014; 46(4):284-8. DOI: 10.5603/AIT.2014.0046. View

12.

Kirkham F, Padayachee T, Parsons S, Seargeant L, House F, GOSLING R . Transcranial measurement of blood velocities in the basal cerebral arteries using pulsed Doppler ultrasound: velocity as an index of flow. Ultrasound Med Biol. 1986; 12(1):15-21. DOI: 10.1016/0301-5629(86)90139-0. View

13.

Kadoi Y, Saito S, Takahashi K . The comparative effects of sevoflurane versus isoflurane on cerebrovascular carbon dioxide reactivity in patients with previous stroke. J Anesth. 2008; 22(2):135-9. DOI: 10.1007/s00540-008-0608-4. View

14.

Smielewski P, Czosnyka M, Kirkpatrick P, McEroy H, RUTKOWSKA H, Pickard J . Assessment of cerebral autoregulation using carotid artery compression. Stroke. 1996; 27(12):2197-203. DOI: 10.1161/01.str.27.12.2197. View

15.

Brass L, Pavlakis S, DEVIVO D, Piomelli S, Mohr J . Transcranial Doppler measurements of the middle cerebral artery. Effect of hematocrit. Stroke. 1988; 19(12):1466-9. DOI: 10.1161/01.str.19.12.1466. View

16.

Summors A, Gupta A, Matta B . Dynamic cerebral autoregulation during sevoflurane anesthesia: a comparison with isoflurane. Anesth Analg. 1999; 88(2):341-5. DOI: 10.1097/00000539-199902000-00022. View

17.

Ogawa Y, Iwasaki K, Aoki K, Kojima W, Kato J, Ogawa S . Dexmedetomidine weakens dynamic cerebral autoregulation as assessed by transfer function analysis and the thigh cuff method. Anesthesiology. 2008; 109(4):642-50. DOI: 10.1097/ALN.0b013e3181862a33. View

18.

Molnar C, Settakis G, Sarkany P, Kalman S, Szabo S, Fulesdi B . Effect of sevoflurane on cerebral blood flow and cerebrovascular resistance at surgical level of anaesthesia: a transcranial Doppler study. Eur J Anaesthesiol. 2006; 24(2):179-84. DOI: 10.1017/S0265021506001335. View

19.

Lam J, Smielewski P, Czosnyka M, Pickard J, Kirkpatrick P . Predicting delayed ischemic deficits after aneurysmal subarachnoid hemorrhage using a transient hyperemic response test of cerebral autoregulation. Neurosurgery. 2000; 47(4):819-25; discussions 825-6. DOI: 10.1097/00006123-200010000-00004. View

20.

Keniya V, Ladi S, Naphade R . Dexmedetomidine attenuates sympathoadrenal response to tracheal intubation and reduces perioperative anaesthetic requirement. Indian J Anaesth. 2011; 55(4):352-7. PMC: 3190508. DOI: 10.4103/0019-5049.84846. View