We have examined cerebral pressure autoregulation while awake, and during 0.5 and 1.5 MAC of sevoflurane anaesthesia in 10 patients undergoing non-intracranial neurosurgical procedures. All patients received a standardized anaesthetic comprising premedication with temazepam 20 mg orally, a sleep dose of propofol, fentanyl 1 microgram kg-1 and vecuronium 0.1 mg kg-1. After tracheal intubation, the lungs were ventilated with a mixture of air and oxygen to mild hypocapnia. Routine monitors included ECG, continuous and intermittent non-invasive arterial pressure, pulse oximetry and end-tidal capnography. In addition, blood flow velocity (vmca) was measured by insonating the middle cerebral artery transtemporally using a 2-MHz transcranial Doppler probe. Cerebral pressure autoregulation was tested by increasing mean arterial pressure (MAP) by approximately 20 mm Hg using an infusion of phenylephrine and simultaneously recording vmca. The index of autoregulation (IOR) during each period of the study, calculated as the ratio of percentage change in estimated cerebral vascular resistance (CVRe = MAP/vmca) to percentage change in MAP, was compared using ANOVA. vmca during 0.5 and 1.5 MAC of sevoflurane anaesthesia was significantly lower than that while awake (mean 79 (SD 24), 54 (15) and 51 (12) cm s-1, respectively; P < 0.05). There was no significant change in vmca with the increase in MAP while awake, or during 0.5 or 1.5 MAC of sevoflurane anaesthesia and IOR was similar under the three conditions (0.82 (0.11), 0.83 (0.04) and 1.0 (0.03), respectively). We conclude that cerebral pressure autoregulation remained intact during sevoflurane anaesthesia in humans.

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The objective of this study was to analyse the temporal course of the jugular venousarterial gradient of S-100B protein after severe head injury and the correlation between the absolute concentrations of serum S-100B protein and outcome, CT findings, and clinical variables.