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NEUROSURGICAL ANESTHESIA

The Dose-Dependent Effects of Isoflurane on Outcome from Severe Forebrain Ischemia in the Rat

Ikuko Nasu, MD^*, Noriko Yokoo, MD, PhD^*, Seiji Takaoka, MD, PhD^*, Kosuke Takata, MD^*, Tamie Hoshikawa, MD^*, Masayuki Okada, MD^*, and Yoshihide Miura, MD, PhD

From the *Department of Anesthesiology, Yamagata University School of Medicine, Yamagata, Japan; and the Department of Dental Anesthesiology, Health Sciences University of Hokkaido, Japan.

Address correspondence and reprint requests to Yoshihide Miura, MD, PhD, Department of Dental Anesthesiology, Health Sciences University of Hokkaido, Japan, 061-0293. Address e-mail to ymiura{at}hoku-iryo-u.ac.jp.

Isoflurane improves outcome against cerebral ischemia in the rat. However, the optimal neuroprotective concentration has not been defined. We examined the effects of different isoflurane concentrations on outcome from severe forebrain ischemia in the rat. Fasted rats were subjected to 0.5, 1.0, 1.5, 2.0, or 2.5 minimum alveolar concentration (MAC) isoflurane during 10 min bilateral carotid occlusion plus systemic hypotension. Each isoflurane concentration was administered only before ischemia. Arterial blood pressure was not pharmacologically manipulated. After ischemia, the anesthetic regimen was changed to fentanyl/nitrous oxide and maintained for 2 h. Pericranial temperature was maintained normothermic during the experiment. Neuromotor score, % dead hippocampal CA1 neurons, and cortical injury were measured 5 days postischemia. Preischemic arterial blood pressure decreased as MAC was increased. Animals administered >1.0 MAC frequently exhibited postischemic seizures resulting in increased mortality. There was no difference among MAC conditions for % dead CA1 neurons (93 95%). In the cortex, neuronal necrosis was less severe with 0.5 MAC and 1.0 MAC isoflurane relative to >1.0 MAC values. The neuromotor score in the 1.0 MAC isoflurane group was superior to the 2.5 MAC group. Dose-dependent effects of preischemic administration of isoflurane on histologic and behavioral outcome after severe forebrain ischemia were observed. Isoflurane MAC values <1.5 provided superior overall outcome relative to larger isoflurane concentrations.

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