inhalational effects on cerebral physiology |

inhalational effects on cerebral physiology

Tue, 11/06/2007 - 20:31 — oxygen

INHALATIONAL ANESTHETIC effects on cerebral physiology Listen to Audio volatile anesthetics

-cerebral metabolic rate of oxygen -cerebral blood flow -cerebral blood volume -intracranial pressure -seizure activity Nitrous oxide General: decreased CMR02 increased CBF (increased CBV) increased ICP -decreased CMR02 and increased CBF creates "luxury perfusion" -increased CBF occurs generally due to vasodilation of cerebral vessels -with increased CBF there may be an increased CBV although the relationship is not directly proportional -with increased CBF and CBV there may be an increased ICP -patients with decreased intracranial compliance may have marked increase in ICP with inhaltional anesthetics CMR02 -greatest reduction of CMR02 occurs with Enflurane and Isoflurane ( approx 50% reduction of CMR02) -isoflurane reduction of CMR02 is mostly in the neocortex -least reduction of CMR02 is with halothane (approx 25% reduction of CMR02) CBV ( at equivalent MAC values and MAP) - greattest increase in CBF occurs with Halothane ( approx 200% increase of CBF: general increase throughout the brain) -Enflurane has an increase in CBF (approx. 40%) -Isoflurane has an increase in CBF (approx 20%) CBF primarily increased in the subcortical and hindbrain portions ICP -isoflurane is considered the drug of choice for patients with decreased intracranial compliance in prevention of increased ICP Seizure Activity - Enflurane has increased association with seizure activity with MAC values around 1.5-2.0 - Enflurane seizure activity charecterised as spike and wave activity which may be potentiated with auditory stimuli

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