Desflurane and isoflurane have similar effects on cerebral blood flow in patients with intracranial mass lesions

Abstract

Background: Before desflurane is advocated for patients undergoing neurosurgical procedures, it is necessary to determine the effect of desflurane on cerebral blood flow (CBF). In this study, CBF values are compared between desflurane and isoflurane at two doses. In addition, CBF reactivity to CO2 and the effect of prolonged exposure were compared between the two agents. Methods: Cerebral blood flow measurements with intravenous 133Xe were performed in 24 patients undergoing craniotomy for mass lesions, randomized to receive either isoflurane or desflurane in oxygen and air. Cerebral blood flow was determined at 1 and 1.5 MAC concentrations at Pa(CO2) of 25 mmHg in the absence of surgical stimulation. Intraoperatively, with 1.25 MAC anesthesia, CBF was determined at target Pa(CO2) of 25 and 35 mmHg. In 15 patients, an additional measurement at 1.25 MAC was made before closure. Results: At 1.0 MAC, mean ± SD CBF values for the desflurane and isoflurane groups were 18 ± 2 and 20 ± 3 ml · 100 g-1 · min-1, respectively. At 1.5 MAC, CBF values were the same for the two anesthetics; 17 ± 3 ml · 100 g-1 · min-1 for isoflurane and 19 ± 4 ml · 100 g-1 · min-1 for desflurane. During 1.25 MAC anesthesia, there were no differences between groups, with CO2 reactivity 1.3 ± 1.2 ml · 100 g-1 · min-1 · mmHg-1 for desflurane and 1.6 ± 0.6 ml · 100 g-1 · min-1 · mmHg-1 for isoflurane. There was no demonstrable decrease in CBF with prolonged exposure to either agent. Conclusions: Desflurane and isoflurane are similar in terms of absolute CBF, the response to increasing doses, and the preservation of CO2 reactivity.