The effect of propofol-sufentanil intravenous anesthesia on systemic and cerebral circulation, cerebral autoregulation and CO2 reactivity: a case series

Marianna Juhász, Dénes Páll, Béla Fülesdi, Levente Molnár, Tamás Végh, Csilla Molnár, Marianna Juhász, Dénes Páll, Béla Fülesdi, Levente Molnár, Tamás Végh, Csilla Molnár

Abstract

Background and objectives: The aim of our study was to assess systemic and cerebral hemodynamic changes as well as cerebral CO2-reactivity during propofol anesthesia.

Methods: 27 patients undergoing general anesthesia were enrolled. Anesthesia was maintained using the Target-Controlled Infusion (TCI) method according to the Schnider model, effect site propofol concentration of 4 μg.mL-1. Ventilatory settings (respiratory rate and tidal volume) were adjusted to reach and maintain 40, 35, and 30 mmHg EtCO2 for 5 minutes, respectively. At the end of each period, transcranial Doppler and hemodynamic parameters using applanation tonometry were recorded.

Results: Systemic mean arterial pressure significantly decreased during anesthetic induction and remained unchanged during the entire study period. Central aortic and peripherial pulse pressure did not change significantly during anesthetic induction and maintenance, whereas augmentation index as marker of arterial stiffness significantly decreased during the anesthetic induction and remained stable at the time points when target CO2 levels were reached. Both cerebral autoregulation and cerebral CO2-reactivity was maintained during propofol anesthesia.

Conclusions: Propofol at clinically administered doses using the Total Intravenous Anesthesia (TIVA/TCI) technique decreases systemic blood pressure, but does not affect static cerebral autoregulation, flow-metabolism coupling and cerebrovascular CO2 reactivity. According to our measurements, propofol may exert its systemic hemodynamic effect through venodilation.

Trial registration: The study was registered at http://www.clinicaltrials.gov, identifier: NCT02203097, registration date: July 29, 2014.

Keywords: Applanation tonometry; CO(2)-reactivity; Cerebral autoregulation; Cerebral blood flow; Propofol; Transcranial Doppler.

Copyright © 2021 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

Figures

Figure 1
Figure 1
Flow chart of the study.
Figure 2
Figure 2
Applanation tonometry parameters at rest and during the course of the study. Medians and CI values are shown. **Indicates p < 0.01, ***Indicates p < 0.001 difference as compared to steady state values.
Figure 3
Figure 3
(a and b) Changes of middle cerebral artery mean blood flow velocity (panel a) and pulsatility index (panel b) during the course of the study. Medians and CI values are shown. **Indicates p < 0.01, ***Indicates p < 0.001 differences as compared to steady state values.
Figure 4
Figure 4
Spearman correlation between the %–change of Mean Arterial Pressure (MAP) and %–change of the Middle Cerebral Artery mean blood flow Velocity (MCAV) from baseline to anesthetic induction, reaching the steady state.
Figure 5
Figure 5
The proposed mechanism of action of propofol on cerebral blood flow regulation.

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