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PEDIATRIC ANESTHESIA

The Effects of Sevoflurane and Halothane Anesthesia on Cerebral Blood Flow Velocity in Children

Departments of Pediatric Intensive Care and *Pediatric Anesthesia, University Children’s Hospital, Zürich, Switzerland

Address correspondence and reprint requests to Uwe Schwarz, MD, Department of pediatric Anesthesia, University Children’s Hospital, Steinwiesstr. 75, 8032 Zürich, Switzerland. Address e-mail to u.schwarz{at}switzerland.org

We compared cerebral blood flow velocity during anesthesia with sevoflurane and halothane in 23 children admitted for elective surgery (age, 0.4–9.7 yr; median age, 1.9 yr; ASA physical status I–II). Inhaled induction was performed in a randomized sequence with sevoflurane or halothane. Under steady-state conditions, cerebral blood flow velocity (systolic [V_s], mean [V_mn], and diastolic [VD]) were measured by a blinded investigator using transcranial pulsed Doppler ultrasonography. The anesthetic was then changed. CBFV measurements were repeated after washout of the first anesthetic and after steady-state of the second (equivalent minimal alveolar concentration to first anesthetic). The resistance index was calculated. VD and V_mn were significantly lower during sevoflurane (V_mn 1.35 m/s) than during halothane (V_mn 1.50 m/s; P = 0.001), whereas V_s was unchanged. The resistance index was lower during halothane (P < 0.001). Our results indicate lower vessel resistance and higher mean velocity during halothane than during sevoflurane.

Implications: The mean cerebral blood flow velocity is significantly decreased in children during inhaled anesthesia with sevoflurane than during halothane. This might be relevant for the choice of anesthetic in children with risk of increased intracranial pressure, neurosurgery, or craniofacial osteotomies.

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