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PEDIATRIC ANESTHESIA

The Effect of Sevoflurane on Cerebral Autoregulation in Young Children as Assessed by the Transient Hyperemic Response

Department of Anesthesia, Hospital for Sick Children, Toronto, Ontario, Canada

Address correspondence and reprint requests to Gordon Wong, FANZCA, Hospital for Sick Children, Department of Anesthesia, 555 University Avenue, Toronto, ON M5G 1X8, Canada. Address email to gordontcwong{at}hotmail.com.

The transient hyperemic response (THR) test is a simple, noninvasive technique to evaluate cerebral autoregulation using transcranial Doppler. It has not yet been used in studies involving children. In this study we evaluated this response in children undergoing general anesthesia using sevoflurane. Twenty ASA physical status I children undergoing elective urological surgery sequentially received sevoflurane at 0.5, 1.0, and 1.5 MAC in a randomized order. Analgesia was solely provided by caudal anesthesia. The right middle cerebral artery flow velocities before (F1), during (F2), and after (F3) a 10-s ipsilateral carotid artery compression were recorded. The THR ratios (THRR) (± sd) for 0.5 MAC, 1.0 MAC, and 1.5 MAC were 1.24 ± 0.11, 1.16 ± 0.09, and 1.13 ± 0.07, respectively. The THRR was significantly different between 0.5 MAC versus 1.0 and 1.5 MAC, respectively (P < 0.05). However, no difference was detected between 1.0 and 1.5 MAC. A THRR of more than 1.09 has previously been accepted as the lower limit of a positive response. The results in this study suggest that THR is affected by sevoflurane in a dose-dependent fashion but is maintained at up to 1.5 MAC. This suggests cerebral autoregulation is preserved in children anesthetized with up to 1.5 MAC sevoflurane.