Distribution of cerebral blood flow during anesthesia with isoflurane or halothane in humans

Abstract

Background: Halothane and isoflurane have been shown to induce disparate effects on different brain structures in animals. In humans, various methods for measuring cerebral blood flow (CBF) have produced results compatible with a redistribution of CBF toward deep brain structures during isoflurane anesthesia in humans. This study was undertaken to examine the effects of halothane and isoflurane on the distribution of CBF. Methods: Twenty ASA physical status patients (four groups, five in each) anesthetized with either isoflurane or halothane (1 MAC) during normo- or hypocapnia (Pa(CO2) 5.6 or 4.2 kPa (42 or 32 mmHg)) were investigated with a two-dimensional CBF measurement (CBF(xenon), intravenous 133xenon washout technique) and a three-dimensional method for measurement of the regional CBF (rCBF) distribution with single photon emission computer-aided tomography (SPECT; 99mTc-HMPAO). In the presentation of SPECT data, the mean CBF of the brain was defined as 100%, and all relative flow values are related to this value. Results: The mean CBF(xenon) level was significantly influenced by the Pa(CO2) as well as by the anesthetic used. At normocapnia, patients anesthetized with halothane had a mean CBF(xenon) of 40 ± 3 (SE) ISI units. With isoflurane, the flow was significantly (P < 0.01, 33 ± 3 ISI units) less than with halothane. Hypocapnia decreased mean CBF(xenon) (P < 0.0001) during both anesthetics (halothane 24 ± 3, isoflurane 13 ± 2 ISI units). The effects on CBF(xenon), between the anesthetics, differed significantly (P < 0.01) also during hypocapnia. There were significant differences in rCBF distribution measured between the two anesthetics (P < 0.05). During isoflurane anesthesia, there was a relative increase in flow values in subcortical regions (thalamus and basal ganglia) to 10-15%, and in pons to 7- 10% above average. Halothane, in contrast, induced the highest relative flow levels in the occipital lobes, which increased by approximately 10% above average. The rCBF level was increased approximately 10% in cerebellum with both anesthetics. Changes in Pa(CO2) did not alter the rCBF distribution significantly. Conclusions: There is a difference in the human rCBF distribution between halothane and isoflurane with higher relative flows in subcortical regions during isoflurane anesthesia. However, despite this redistribution, isoflurane anesthesia resulted in a lower mean CBF(xenon) than did anesthesia with halothane.