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

Abstract

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.

Comparison of cerebral blood flow during general anesthesia in elderly patients with and without dementia: a prospective controlled clinical trial

“…Meanwhile, 60% of the brain's energy expenditure contributes to electrophysiological functions, and the cerebral metabolic rate (CMR) is related to CBF [39]. MAP and CBF (middle cerebral artery ow velocity) have been reported to be correlated during anesthesia in a study of patients with an average age of 51 years [40], and that in the anesthesia using propofol (1-2 mg/kg), remifentanil (anesthesia induction with 1 µg/kg/min and maintenance using 0.1 µg/kg/min), and sevo urane (< 1 minimum alveolar concentration [MAC]), the MAP and degree of expansion of the internal carotid and middle cerebral arteries are correlated [41]. These reports suggest that MAP and CBF are correlated even under anesthesia.…”

Clinical Results of Flow Diverter Treatments for Cerebral Aneurysms under Local Anesthesia

“…The incidence of airway complications caused by endotracheal intubation ranges from 0.5 to 7% [ 26 ]. Inhaled anesthetic agents have been shown to create significant vasodilation in the cerebral artery, which would give an inaccurate dimension of the vessel, causing the selection of inappropriately sized devices [ 28 ]. This can be avoided by performing the procedure under LA.…”