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Cerebral blood flow, cerebral metabolic rate of oxygen and relative CO 2 reactivity during neurolept anaesthesia in patients subjected to craniotomy for supratentorial cerebral tumours

1988; Wiley; Volume: 32; Issue: 4 Linguagem: Inglês

10.1111/j.1399-6576.1988.tb02735.x

1399-6576

Georg E. Cold, K. J. S. Christensen, Jens Munch Nordentoft, Marianne Engberg, M. Bach Pedersen,

Glioma Diagnosis and Treatment

In 10 patients subjected to craniotomy for supratentorial cerebral tumours in neurolept anaesthesia, cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRo 2 ) were measured twice peroperatively by a modification of the Kety & Schmidt technique, using 133 Xe. The relative CO 2 reactivity was assessed indirectly as the % change of the arterio–venous oxygen difference (AVDo 2 ) per mm change in Paco 2 . The patients were premedicated with diazepam 10–15 mg perorally. For induction, thiopentone 4—‐6 mg/kg, droperidol 0.2 mg/kg and fentanyl 5 μg/kg were used, and for maintenance N 2 O 67% and fentanyl 4 μg/ kg/h. During the first flow measurement the median and range of CBF was 30 ml/100 g/min (range 17–45), of AVDo 2 8.0 vol % (range 4.1–9.5), and of CMRo 2 2.28 ml O 2 /100 g/min (range 1.57‐2.84). During tin–second CBF study, AVDo 2 increased to 9.3 vol % (range 3.4–11) ( P < 0.05), and CMRo 2 increased to 2.51 ml O 2 /100 g/min (range 1.88‐3.00) P < 0.05, while CBF was unchanged. The CO 2 reactivity was present in all studies, median 1.8 %/mmHg (range 0.5–15.1). The correlation coefficients between jugular venous oxygen tension/saturation, respectively, and CBF were high at tensions/saturations exceeding 4.0 kPa and 55%, indicating that hyperperfusion is easily unveiled by venous samples from the jugular vein during this anaesthesia.