The effects of sevoflurane anesthesia on hemodynamics and cerebral artery diameters in endovascular treatment of intracranial aneurysm: A pilot study

CONCLUSION: In patients undergoing flow diverter devices, <1 MAC sevoflurane has a hemodynamic effect and creates significant vasodilation in the cerebral artery diameters

📌 3 Key Takeaways

🎯

Objective & Hypothesis:BACKGROUND: Cerebral autoregulation is a steady-state of cerebral blood flow despite major changes in arterial blood pressure.

📊

Key Findings & Data:In <1 MAC values, the net effect is a moderate decrease in cerebral blood flow and maintenance of responsiveness to carbon dioxide.

💡

Conclusion & Impact:CONCLUSION: In patients undergoing flow diverter devices, <1 MAC sevoflurane has a hemodynamic effect and creates significant vasodilation in the cerebral artery diameters

🔬Design:Research Article

📍Scope:Comprehensive Sample

⚙️Variables:Domain Parameters

Özet

BACKGROUND: Cerebral autoregulation is a steady-state of cerebral blood flow despite major changes in arterial blood pressure. Inhalation anesthetics are cerebral vasodilators. In <1 MAC values, the net effect is a moderate decrease in cerebral blood flow and maintenance of responsiveness to carbon dioxide. This study aims to investigate the effects of steady-state sevoflurane anesthesia on hemodynamic and cerebral artery diameter measurements in patients undergoing flow diverter device placement under general anesthesia. METHODS: Forty-six patients aged 18–70 years who underwent flow diverter devices under general anesthesia were included in this study. Routine monitoring was performed on the patients. Mean arterial pressure (MAP) values were recorded. Internal carotid artery, middle cerebral artery and anterior cerebral artery diameter measurements were made from digital subtraction angiography (DSA) images of patients with anterior aneurysms. Baseline artery, right posterior cerebral artery and left posterior cerebral artery diameter measurements were made from DSA images of patients with posterior aneurysms. These measurements were recorded as preoperative measurements. The same measurements were made from the DSA images performed before the Flow diverter device placement procedure performed under steady-state sevoflurane anesthesia for the same patients. These measurements were recorded as peroperative measurements. RESULTS: The average age of the patients was 56.6±15.1. The MAP of the patients before induction was 76.28±5.13 mmHg, MAP after induction was 64.36±3.23 mmHg, and MAP during sevoflurane anesthesia was 68.26±4.30 mmHg, there was a statistically significant difference. There was a statistically significant difference between the preoperative and perioperative values of anterior cerebral artery diameters. There was a strong relationship between the MAP change percentage and the ICA diameter change percentage (p<0.001, p=-0.785) and a moderate relationship between the MCA diameter change percentage (p=0.033, p=-0.338). CONCLUSION: In patients undergoing flow diverter devices, <1 MAC sevoflurane has a hemodynamic effect and creates significant vasodilation in the cerebral artery diameters

🔖

Cite This Article

ARICAN, Ş., HACIBEYOĞLU, G., YILMAZ, R., TAVLAN, A., UZUN, S. T., BAKDIK, S., KOÇ, O. (2021). The effects of sevoflurane anesthesia on hemodynamics and cerebral artery diameters in endovascular treatment of intracranial aneurysm: A pilot study. Ulusal Travma ve Acil Cerrahi Dergisi, Cilt: 27 - Sayı: 2, 200–206. https://ajindex.com/articles/398786

📄 Full Text PDF Viewer

Open in New Tab ↗

↗New Tab

📄

PDF görüntüleyici hazırlanıyor...

References (12)

Austin GM, Schievink W, Williams R. Controlled pressure-volume factors in the enlargement of intracranial aneurysms. Neurosurgery 1989;24:722−30
Briganti F, Leone G, Marseglia M, Mariniello G, Caranci F, Brunetti A, et al. Endovascular treatment of cerebral aneurysms using flow-diverter devices: A systematic review. Neuroradiol J 2015;28:365−75
Griessenauer CJ, Shallwani H, Adeeb N, Gupta R, Rangel-Castilla L, Siddiqui AH, et al. Conscious Sedation Versus General Anesthesia for the Treatment of Cerebral Aneurysms with Flow Diversion: A Matched Cohort Study. World Neurosurg 2017;102:1-5
Chamczuk AJ, Ogilvy CS, Snyder KV, Ohta H, Siddiqui AH, Hopkins LN, et al. Elective stenting for intracranial stenosis under conscious sedation. Neurosurgery 2010;67:1189−93; discussion 1194
Joung KW, Yang KH, Shin WJ, Song MH, Ham K, Jung SC, et al. Anesthetic consideration for neurointerventional procedures. Neurointervention 2014;9:72−7
Werner CKE, Hoffmann WE. Cerebral blood flow and metabolism. In: Albin MS, editor. Textbook of Neuroanesthesia with Neurosurgical and Neuroscience Perspectives. New York: McGraw-Hill; 1997.p.21–59
Settakis G, Molnár C, Kerényi L, Kollár J, Legemate D, Csiba L, et al. Acetazolamide as a vasodilatory stimulus in cerebrovascular diseases and in conditions affecting the cerebral vasculature. Eur J Neurol 2003;10:609−20
Lindegaard KF, Nornes H, Bakke SJ, Sorteberg W, Nakstad P. Cerebral vasospasm diagnosis by means of angiography and blood velocity measurements. Acta Neurochir (Wien) 1989;100:12−24
Hansen TD, Warner DS, Todd MM, Vust LJ. The role of cerebral metabolism in determining the local cerebral blood flow effects of volatile anesthetics: evidence for persistent flow-metabolism coupling. J Cereb Blood Flow Metab 1989;9:323−8
Juhász M, Molnár L, Fülesdi B, Végh T, Páll D, Molnár C. Effect of sevoflurane on systemic and cerebral circulation, cerebral autoregulation and CO2 reactivity. BMC Anesthesiol 2019;19:109
Holzer A, Greher M, Hetz H, Standhardt H, Donner A, Heinzl H, et al. Influence of aortic blood flow velocity on changes of middle cerebral artery blood flow velocity during isoflurane and sevoflurane anaesthesia. Eur J Anaesthesiol 2001;18:238−44
Diringer MN, Bleck TP, Claude Hemphill J 3rd, Menon D, Shutter L, Vespa P, Bruder N, et al; Neurocritical Care Society. Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritica