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Effects Of Anesthetics On Cerebral Blood Flow

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Unnikrishnan Prathapadas
Unnikrishnan Prathapadas

This document discusses the effects of anesthetics on cerebral blood flow and cerebral metabolic rate of oxygen. It explains that anesthetics generally suppress brain metabolism and appetite, leading to decreased cerebral blood flow and intracranial pressure. Specific anesthetics like barbiturates, propofol, volatile agents, and nitrous oxide are discussed in terms of their effects on cerebral blood flow, cerebral metabolic rate, intracranial pressure, and other factors. The importance of maintaining proper cerebral perfusion pressure during neuroanesthesia is also emphasized.

Saúde e medicina
1 de 72
EFFECTS OF ANESTHETICS ON CEREBRAL BLOOD FLOW & CMRO2 PRESENTER Dr Unnikrishnan P COORDINATOR Dr Linnette Morris MODERATORS Dr Ushakumari Dr Chitra
Why this session…? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Keep the terms close to your heart…. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CBV-CBF ,[object Object],[object Object],[object Object]
CBV AND AUTOREGULATION ,[object Object],[object Object],[object Object],[object Object]
Epileptogenesis -concerns ,[object Object],[object Object]
INTRAVENOUS ANESTHETICS ,[object Object]
I V ANESTHETICS ,[object Object],[object Object],[object Object],[object Object],[object Object]
BARBITURATES ,[object Object],[object Object],[object Object],[object Object]
Barbiturates…. ,[object Object],[object Object],[object Object],[object Object],[object Object],Suppression of CMR Free radical scavenging CBF redistribution effects Decrease ATP consumption
Barbiturates …. ,[object Object],[object Object],[object Object]
ABOUT METHOHEXITAL ,[object Object],[object Object],[object Object]
PROPOFOL ,[object Object],[object Object],[object Object],[object Object],[object Object]
Propofol and seizure incidence ,[object Object],[object Object],[object Object],[object Object],[object Object]
Propofol & brain protection
Etomidate ,[object Object],[object Object],[object Object],[object Object]
ETOMIDATE continued ,[object Object],[object Object],[object Object],[object Object]
NARCOTICS ,[object Object],[object Object],[object Object],[object Object]
MORPHINE ,[object Object],[object Object],[object Object]
FENTANYL & ALFENTANYL ,[object Object],[object Object],[object Object],[object Object],[object Object]
Fentanyl ,[object Object],[object Object],[object Object],[object Object]
SUFENTANYL ,[object Object],[object Object],[object Object],[object Object]
REMIFENTANYL ,[object Object],[object Object]
Benzodiazepines ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
FLUMAZENIL # true or false # ,[object Object],[object Object],[object Object],[object Object]
DROPERIDOL ,[object Object],[object Object],[object Object]
KETAMINE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
LIDOCAINE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
INHALED ANAESTHETICS
VOLATILE AGENTS….
EFFECTS @ DIFFERENT MACs
Beyond 1 MAC what happens? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Volatile agents Also…… ,[object Object],[object Object]
Continued (general properties) volatile agents ,[object Object],[object Object],[object Object],[object Object]
HALOTHANE ,[object Object],[object Object],[object Object],[object Object]
Halothane….. continued ,[object Object],[object Object],[object Object],[object Object]
ENFLURANE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ISOFLURANE ,[object Object],[object Object],[object Object],[object Object],[object Object]
Isoflurane more ,[object Object],[object Object],[object Object]
SEVOFLURANE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
DESFLURANE ,[object Object],[object Object],[object Object],[object Object]
Summary of volatile agents MAJOR IMPACT ON CBF/CBV & ICP OCCURS WHEN WE EXCEED 1 MAC BECOMES SIGNIFICANT IF INTRACRANIAL COMPLIANCE IS ABNORMAL HERE, IT IS BETTER TO USE A PREDOMINANTLY INTRAVENOUS TECHNIQUE UNTIL THE POINT OF OPENING OF CRANIUM & DURA NET VASODILATORY EFFECT OF ISO/DES & SEVO LESS THAN HALO;SO IF ONE IS TO BE USED, PREFER THE FORMER ONES EFFECT OF HYPOCAPNOEA : HALOTHANE Vs ISO/DES/SEVO ENFLURANE IS EPILEPTOGENIC; SLIGHT RISK WITH SEVOFLURANE CO2 REACTIVITY AND AUTOREGULATION PRESERVED
NITROUS OXIDE ,[object Object],[object Object],[object Object],[object Object],[object Object]
Nitrous oxide… ,[object Object],[object Object],[object Object]
N2O continued ,[object Object],[object Object]
MUSCLE RELAXANTS
NON DEPOLARIZING RELAXANTS ,[object Object],[object Object],[object Object],[object Object]
Non depolarizing relaxants- histamine release
NDMR continued ,[object Object],[object Object],[object Object],[object Object]
Message…. NDMR use ,[object Object],[object Object],[object Object],[object Object]
SUCCINYL CHOLINE ,[object Object],[object Object],[object Object],[object Object],[object Object],Deep anesthesia Defasciculation with metocurine 0.03 mg/kg “ paralysis with Vecuronium”
Also know ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Textbook of neuroanesthesia & criticalcare/Basil F Matta SURGERY INDUCTION RELAXANT MAINTENANCE SUPRATENTORIAL ICSOL TPS/P’FOL ATRA/VEC/MIVA/ROC P’FOL-FENT / FENT- LD ISO / N2O- HD ISO VASCULAR Sx TPS/ETO/P’FOL VEC/ATRAC/PAN/? SCOLINE* P’FOL-OPIOID +/- VOL AGENT* ?N2O CAROTID Sx FENT/ETO/TPS/ P’FOL VEC FENT/ISO/N2O POST FOSSA OPIOID/TPS/ P’FOL NDMR VARIES ?N2O-PC/VAE ?VOL-TRANS PUL,SSEP NSx WITHOUT CRANIOTOMY FENT/TPS/P’FOL NDMR ISO WITH HYPOCAPNOEA Cx SPINE RSI-SCOLINE PED TPS/P’FOL/SEVO SUXA/NDMR N2O+LD ISO/SEV OR P’FOL i/FEN OR AIR+HD VA
. ,[object Object],[object Object]
REFERENCES ,[object Object],[object Object],[object Object],[object Object]
BRAIN PROTECTION ,[object Object]
COMPLETE GLOBAL ISCHEMIA ,[object Object],INDUCTION OF MILD HYPOTHERMIA IN THE RANGE OF 32-32 ^C X 24 HRS  PASSIVE REWARMING OVER 8 HRS CALCIUM CHANNEL BLOCKER NIMODIPINE NORMALIZATION OF pH Rx OF SEIZURES NORMOTENSION
FOCAL [INCOMPLETE] ISCHEMIA ,[object Object]
Thiopentone ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Propofol ,[object Object],[object Object],[object Object]
ISOFLURANE/VOLATILE AGENTS ,[object Object],[object Object],[object Object]
ETOMIDATE ,[object Object],[object Object],[object Object],[object Object]
Others ,[object Object],[object Object],[object Object]
. ,[object Object],[object Object]
REFERENCES ,[object Object],[object Object],[object Object],[object Object]
F ,[object Object]
 
r ,[object Object]
r ,[object Object]
 
 
 

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Effects Of Anesthetics On Cerebral Blood Flow

  • 1. EFFECTS OF ANESTHETICS ON CEREBRAL BLOOD FLOW & CMRO2 PRESENTER Dr Unnikrishnan P COORDINATOR Dr Linnette Morris MODERATORS Dr Ushakumari Dr Chitra
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  • 42. Summary of volatile agents MAJOR IMPACT ON CBF/CBV & ICP OCCURS WHEN WE EXCEED 1 MAC BECOMES SIGNIFICANT IF INTRACRANIAL COMPLIANCE IS ABNORMAL HERE, IT IS BETTER TO USE A PREDOMINANTLY INTRAVENOUS TECHNIQUE UNTIL THE POINT OF OPENING OF CRANIUM & DURA NET VASODILATORY EFFECT OF ISO/DES & SEVO LESS THAN HALO;SO IF ONE IS TO BE USED, PREFER THE FORMER ONES EFFECT OF HYPOCAPNOEA : HALOTHANE Vs ISO/DES/SEVO ENFLURANE IS EPILEPTOGENIC; SLIGHT RISK WITH SEVOFLURANE CO2 REACTIVITY AND AUTOREGULATION PRESERVED
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  • 53. Textbook of neuroanesthesia & criticalcare/Basil F Matta SURGERY INDUCTION RELAXANT MAINTENANCE SUPRATENTORIAL ICSOL TPS/P’FOL ATRA/VEC/MIVA/ROC P’FOL-FENT / FENT- LD ISO / N2O- HD ISO VASCULAR Sx TPS/ETO/P’FOL VEC/ATRAC/PAN/? SCOLINE* P’FOL-OPIOID +/- VOL AGENT* ?N2O CAROTID Sx FENT/ETO/TPS/ P’FOL VEC FENT/ISO/N2O POST FOSSA OPIOID/TPS/ P’FOL NDMR VARIES ?N2O-PC/VAE ?VOL-TRANS PUL,SSEP NSx WITHOUT CRANIOTOMY FENT/TPS/P’FOL NDMR ISO WITH HYPOCAPNOEA Cx SPINE RSI-SCOLINE PED TPS/P’FOL/SEVO SUXA/NDMR N2O+LD ISO/SEV OR P’FOL i/FEN OR AIR+HD VA
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