Obstetrical and Pediatric Anesthesia-Cerebrovascular reactivity to carbon dioxide is preserved during hypocapnia in children anesthetized with 1.0 MAC, but not with 1.5 MAC desflurane

摘要: Purpose Maintenance of cerebrovascular reactivity to CO2 (CCO2R) is important during neurosurgical anesthesia. This study was designed to determine the effect of different desflurane concentrations on CCO2R in children. Methods Children undergoing urological surgery were enrolled. Anesthesia was induced with sevoflurane in air/oxygen. After intubation, sevoflurane was switched to desflurane. Analgesia was provided with an epidural neuraxial block. Mechanical ventilation was adjusted to an initial EtCO2 of 30 mmHg. Exogenous CO2 was used to achieve an EtCO2 of 40 and 50 mmHg. Patients were randomized to the sequence of desflurane concentration (1.0 and 1.5 MAC) and the EtCO2. Transcranial Doppler was used to measure middle cerebral artery blood flow velocity (Vmca). Five minutes were allowed to reach steady state after each change in EtCO2 and 15 min after changing the desflurane …