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NEUROSURGICAL ANESTHESIA

The Comparative Effects of Sevoflurane Versus Isoflurane on Cerebrovascular Carbon Dioxide Reactivity in Patients with Diabetes Mellitus

From the Department of Anesthesiology, Gunma University, Graduate School of Medicine, Japan.

Address correspondence and reprint requests to Yuji Kadoi, MD, Department of Anesthesiology, Gunma University, Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan. Address e-mail to kadoi{at}med.gunma-u.ac.jp.

The use of volatile anesthetics has been reported to alter cerebrovascular carbon dioxide (CO₂) reactivity. We examined the comparative effects of sevoflurane versus isoflurane on cerebrovascular CO₂ reactivity in 40 patients with diabetes mellitus. Anesthesia was maintained with either 1.0 minimum alveolar anesthetic concentration of sevoflurane or 1.0 minimum alveolar anesthetic concentration of isoflurane in 33% oxygen and 67% nitrous oxide. A 2.5-MHz pulsed transcranial Doppler probe was attached to the patient's head at the right temporal window for continuous measurement of mean blood flow velocity in the middle cerebral artery. After establishing baseline middle cerebral artery velocity values and cardiovascular hemodynamics, we increased end-tidal CO₂ by decreasing ventilatory frequency by 2–5 breaths/min and repeated the measurements. These were then used to calculate absolute and relative CO₂ reactivity. Absolute CO₂ reactivity was less in insulin-treated patients with either sevoflurane or isoflurane compared with those patients on oral antidiabetic drugs or dietary therapy (sevoflurane group: diet = 2.6 ± 0.6; oral antidiabetic drug = 2.5 ± 0.8; insulin = 1.6 ± 0.8*; isoflurane group: diet = 3.3 ± i0.7; oral antidiabetic drug = 3.4 ± 0.7; insulin = 1.9 ± 0.7* cm · s^–1 · mm Hg^–1; *P < 0.05, respectively). Relative CO₂ reactivity showed a similar pattern in the diet-controlled and oral antidiabetic groups, absolute and relative CO₂ reactivities were lower with sevoflurane versus isoflurane. Hence, we conclude that cerebrovascular CO₂ reactivity in insulin-dependent patients is impaired under both sevoflurane and isoflurane anesthesia.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999