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Impact of stepwise hyperventilation on cerebral tissue oxygen saturation in anesthetized patients: A mechanistic study

  • Author(s): Alexander, BS
  • Gelb, AW
  • Mantulin, WW
  • Cerussi, AE
  • Tromberg, BJ
  • Yu, Z
  • Lee, C
  • Meng, L
  • et al.

Published Web Location

https://doi.org/10.1111/aas.12054Creative Commons Attribution 4.0 International Public License
Abstract

Background: While the decrease in blood carbon dioxide (CO2) secondary to hyperventilation is generally accepted to play a major role in the decrease of cerebral tissue oxygen saturation (SctO2), it remains unclear if the associated systemic hemodynamic changes are also accountable. Methods: Twenty-six patients (American Society of Anesthesiologists I-II) undergoing nonneurosurgical procedures were anesthetized with either propofol-remifentanil (n = 13) or sevoflurane (n = 13). During a stable intraoperative period, ventilation was adjusted stepwise from hypoventilation to hyperventilation to achieve a progressive change in end-tidal CO2 (ETCO2) from 55 to 25 mmHg. Minute ventilation, SctO2, ETCO2, mean arterial pressure (MAP), and cardiac output (CO) were recorded. Results: Hyperventilation led to a SctO2 decrease from 78 ± 4% to 69 ± 5% (D =-9 ± 4%, P < 0.001) in the propofolremifentanil group and from 81 ± 5% to 71 ± 7% (D =-10 ± 3%, P < 0.001) in the sevoflurane group. The decreases in SctO 2 were not statistically different between these two groups (P = 0.5). SctO2 correlated significantly with ETCO2 in both groups (P < 0.001). SctO2 also correlated significantly with MAP (P < 0.001) and CO (P < 0.001) during propofol-remifentanil, but not sevoflurane (P = 0.4 and 0.5), anesthesia. Conclusion: The main mechanism responsible for the hyperventilation-induced decrease in SctO2 is hypocapnia during both propofol-remifentanil and sevoflurane anesthesia. Hyperventilation-associated increase in MAP and decrease in CO during propofol-remifentanil, but not sevoflurane, anesthesia may also contribute to the decrease in SctO2 but to a much smaller degree. © 2013 The Acta Anaesthesiologica Scandinavica Foundation Published by Blackwell Publishing Ltd.

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