Impact of anesthetic agents on cerebrovascular physiology in children

Paediatric Anaesthesia

Volumn 19, Issue 2, 2009, Pages 108-118

  Szabó, Elöd Z ^a,b   Luginbuehl, Igor ^a   Bissonnette, Bruno ^a  

^a UNIVERSITY OF TORONTO   (Canada)

^b HOSPITAL FOR SICK CHILDREN   (Canada)

Author keywords

Cerebral blood flow; Cerebrovascular regulation; Neuropharmacology of anesthetic agents; Pediatric neuroanesthesia

Indexed keywords

ANESTHETIC AGENT; BENZODIAZEPINE DERIVATIVE; CARBON DIOXIDE; DESFLURANE; ETOMIDATE; FENTANYL; HALOTHANE; ISOFLURANE; KETAMINE; NITROUS OXIDE; OPIATE; PROPOFOL; REMIFENTANIL; SEVOFLURANE; THIOPENTAL;

ANESTHESIA MECHANISM; AUTOREGULATION; BLOOD VISCOSITY; BRAIN BLOOD FLOW; BRAIN BLOOD VESSEL; CEREBROSPINAL FLUID; CEREBROVASCULAR AUTOREGULATION; INTRACRANIAL PRESSURE; OXYGEN TENSION; PEDIATRIC ANESTHESIA; PRIORITY JOURNAL; REVIEW;

ANESTHETICS, INHALATION; ANESTHETICS, INTRAVENOUS; BRAIN; CEREBROSPINAL FLUID; CEREBROVASCULAR CIRCULATION; CHILD; HOMEOSTASIS; HUMANS; INTRACRANIAL PRESSURE; MONITORING, INTRAOPERATIVE; NEUROSURGICAL PROCEDURES; PERIOPERATIVE CARE;

EID: 58849116770     PISSN: 11555645     EISSN: 14609592     Source Type: Journal    
DOI: 10.1111/j.1460-9592.2008.02826.x     Document Type: Review

References (151)

1. Cutler RW, Page L, Galicich J et al. Formation and absorption of cerebrospinal fluid in man. Brain 1968 91 : 707 720.
2. Watters GV, Cutler RW. Cerebrospinal fluid formation and reabsorption in children. Neurology 1968 18 : 296.
3. Marmarou A, Shulman K, LaMorgese J. Compartmental analysis of compliance and outflow resistance of the cerebrospinal fluid system. J Neurosurg 1975 43 : 523 534.
4. Daveson H. Physiology of cerebrospinal fluid. Boston : Little Brown, 1967.
5. Welch K. The intracranial pressure in infants. J Neurosurg 1980 52 : 693 699.
6. Davis A, Ravussin P, Bissonnette B. Central Nervous System: Anatomy and Physiology. In : Bissonnette BD, Dalens B, eds. Pediatric Anesthesia, Principles and Practice, 1st edn. New York : McGraw-Hill, 2002 : pp. 104 113.
7. Borch K, Greisen G. Blood flow distribution in the normal human preterm brain. Pediatr Res 1998 43 : 28 33.
8. Chiron C, Raynaud C, Maziere B et al. Changes in regional cerebral blood flow during brain maturation in children and adolescents. J Nucl Med 1992 33 : 696 703.
9. Ogawa A, Sakurai Y, Kayama T et al. Regional cerebral blood flow with age: changes in rCBF in childhood. Neurol Res 1989 11 : 173 176.
10. Takahashi T, Shirane R, Sato S et al. Developmental changes of cerebral blood flow and oxygen metabolism in children. AJNR Am J Neuroradiol 1999 20 : 917 922.
11. Wass CT, Lanier WL. Glucose modulation of ischemic brain injury: review and clinical recommendations. Mayo Clin Proc 1996 71 : 801 812.
12. Panerai RB. The critical closing pressure of the cerebral circulation. Med Eng Phys 2003 25 : 621 632.
13. Hancock SM, Mahajan RP, Athanassiou L. Noninvasive estimation of cerebral perfusion pressure and zero flow pressure in healthy volunteers: the effects of changes in end-tidal carbon dioxide. Anesth Analg 2003 96 : 847 851, table of contents.
14. Panerai RB, Deverson ST, Mahony P et al. Effects of CO2 on dynamic cerebral autoregulation measurement. Physiol Meas 1999 20 : 265 275.
15. Weyland A, Buhre W, Grund S et al. Cerebrovascular tone rather than intracranial pressure determines the effective downstream pressure of the cerebral circulation in the absence of intracranial hypertension. J Neurosurg Anesthesiol 2000 12 : 210 216.
16. Panerai RB, Kelsall AW, Rennie JM et al. Estimation of critical closing pressure in the cerebral circulation of newborns. Neuropediatrics 1995 26 : 168 173.
17. Buhre W, Heinzel FR, Grund S et al. Extrapolation to zero-flow pressure in cerebral arteries to estimate intracranial pressure. Br J Anaesth 2003 90 : 291 295.
18. Czosnyka M, Smielewski P, Piechnik S et al. Critical closing pressure in cerebrovascular circulation. J Neurol Neurosurg Psychiatry 1999 66 : 606 611.
19. Marval PD, Perrin ME, Hancock SM et al. The effects of propofol or sevoflurane on the estimated cerebral perfusion pressure and zero flow pressure. Anesth Analg 2005 100 : 835 840, table of contents.
20. Paulson OB, Strandgaard S, Edvinsson L. Cerebral autoregulation. Cerebrovasc Brain Metab Rev 1990 2 : 161 192.
21. Lassen NA, Christensen MS. Physiology of cerebral blood flow. Br J Anaesth 1976 48 : 719 734.
22. Milligan DW. Failure of autoregulation and intraventricular haemorrhage in preterm infants. Lancet 1980 1 : 896 898.
23. Munro MJ, Walker AM, Barfield CP. Hypotensive extremely low birth weight infants have reduced cerebral blood flow. Pediatrics 2004 114 : 1591 1596.
24. Hillier SC, Burrows FA, Bissonnette B et al. Cerebral hemodynamics in neonates and infants undergoing cardiopulmonary bypass and profound hypothermic circulatory arrest: assessment by transcranial Doppler sonography. Anesth Analg 1991 72 : 723 728.
25. Vavilala MS, Lee LA, Lee M et al. Cerebral autoregulation in children during sevoflurane anaesthesia. Br J Anaesth 2003 90 : 636 641.
26. Vavilala MS, Lee LA, Lam AM. The lower limit of cerebral autoregulation in children during sevoflurane anesthesia. J Neurosurg Anesthesiol 2003 15 : 307 312.
27. Wong GT, Luginbuehl I, Karsli C et al. The effect of sevoflurane on cerebral autoregulation in young children as assessed by the transient hyperemic response. Anesth Analg 2006 102 : 1051 1055.
28. Lou HC, Lassen NA, Friis-Hansen B. Impaired autoregulation of cerebral blood flow in the distressed newborn infant. J Pediatr 1979 94 : 118 121.
29. Rosenbaum JL, Almli CR, Yundt KD et al. Higher neonatal cerebral blood flow correlates with worse childhood neurologic outcome. Neurology 1997 49 : 1035 1041.
30. Vavilala MS, Lee LA, Boddu K et al. Cerebral autoregulation in pediatric traumatic brain injury. Pediatr Crit Care Med 2004 5 : 257 263.
31. Schmieder K, Schregel W, Harders A et al. Dynamic cerebral autoregulation in patients undergoing surgery for intracranial tumors. Eur J Ultrasound 2000 12 : 1 7.
32. Strebel S, Lam AM, Matta B et al. Dynamic and static cerebral autoregulation during isoflurane, desflurane, and propofol anesthesia. Anesthesiology 1995 83 : 66 76.
33. Bracco D, Bissonnette B. Neurosurgery and Neurotraumatology: Anesthetic Consideration and Postoperative Management. In : Bissonnette BD, Dalens B, eds. Pediatric Anesthesia, Principles and Practice, 1st edn. New York : McGraw-Hill, 2002.
34. Severinghaus JW, Lassen N. Step hypocapnia to separate arterial from tissue PCO2 in the regulation of cerebral blood flow. Circ Res 1967 20 : 272 278.
35. Pilato MA, Bissonnette B, Lerman J. Transcranial Doppler: response of cerebral blood-flow velocity to carbon dioxide in anaesthetized children. Can J Anaesth 1991 38 : 37 42.
36. Gupta AK, Menon DK, Czosnyka M et al. Thresholds for hypoxic cerebral vasodilation in volunteers. Anesth Analg 1997 85 : 817 820.
37. Johnston AJ, Steiner LA, Gupta AK et al. Cerebral oxygen vasoreactivity and cerebral tissue oxygen reactivity. Br J Anaesth 2003 90 : 774 786.
38. Watson NA, Beards SC, Altaf N et al. The effect of hyperoxia on cerebral blood flow: a study in healthy volunteers using magnetic resonance phase-contrast angiography. Eur J Anaesthesiol 2000 17 : 152 159.
39. Amano T, Meyer JS, Okabe T et al. Cerebral vasomotor responses during oxygen inhalation. Results in normal aging and dementia. Arch Neurol 1983 40 : 277 282.
40. Menzel M, Doppenberg EM, Zauner A et al. Cerebral oxygenation in patients after severe head injury: monitoring and effects of arterial hyperoxia on cerebral blood flow, metabolism and intracranial pressure. J Neurosurg Anesthesiol 1999 11 : 240 251.
41. Rogers MC, Nugent SK, Traystman RJ. Control of cerebral circulation in the neonate and infant. Crit Care Med 1980 8 : 570 574.
42. Hudak ML, Jones MD Jr., Popel AS et al. Hemodilution causes size-dependent constriction of pial arterioles in the cat. Am J Physiol 1989 257 : H912 917.
43. Muizelaar JP, Wei EP, Kontos HA et al. Mannitol causes compensatory cerebral vasoconstriction and vasodilation in response to blood viscosity changes. J Neurosurg 1983 59 : 822 828.
44. Muizelaar JP, Lutz HA 3rd., Becker DP. Effect of mannitol on ICP and CBF and correlation with pressure autoregulation in severely head-injured patients. J Neurosurg 1984 61 : 700 706.
45. Rebel A, Ulatowski JA, Kwansa H et al. Cerebrovascular response to decreased hematocrit: effect of cell-free hemoglobin, plasma viscosity, and CO2. Am J Physiol Heart Circ Physiol 2003 285 : H1600 1608.
46. Leon JE, Bissonnette B. Transcranial Doppler sonography: nitrous oxide and cerebral blood flow velocity in children. Can J Anaesth 1991 38 : 974 979.
47. Lorenz IH, Kolbitsch C, Hormann C et al. Influence of equianaesthetic concentrations of nitrous oxide and isoflurane on regional cerebral blood flow, regional cerebral blood volume, and regional mean transit time in human volunteers. Br J Anaesth 2001 87 : 691 698.
48. Reinstrup P, Ryding E, Algotsson L et al. Effects of nitrous oxide on human regional cerebral blood flow and isolated pial arteries. Anesthesiology 1994 81 : 396 402.
49. Field LM, Dorrance DE, Krzeminska EK et al. Effect of nitrous oxide on cerebral blood flow in normal humans. Br J Anaesth 1993 70 : 154 159.
50. Karsli C, Luginbuehl IA, Bissonnette B. The effect of nitrous oxide on cerebral blood flow velocity in children anaesthetised with desflurane. Anaesthesia 2003 58 : 24 27.
51. Rowney DA, Fairgrieve R, Bissonnette B. The effect of nitrous oxide on cerebral blood flow velocity in children anaesthetised with sevoflurane. Anaesthesia 2004 59 : 10 14.
52. Cho S, Fujigaki T, Uchiyama Y et al. Effects of sevoflurane with and without nitrous oxide on human cerebral circulation. Transcranial Doppler study. Anesthesiology 1996 85 : 755 760.
53. Strebel S, Kaufmann M, Anselmi L et al. Nitrous oxide is a potent cerebrovasodilator in humans when added to isoflurane. A transcranial Doppler study. Acta Anaesthesiol Scand 1995 39 : 653 658.
54. Lam AM, Mayberg TS, Eng CC et al. Nitrous oxide-isoflurane anesthesia causes more cerebral vasodilation than an equipotent dose of isoflurane in humans. Anesth Analg 1994 78 : 462 468.
55. Bedforth NM, Girling KJ, Harrison JM et al. The effects of sevoflurane and nitrous oxide on middle cerebral artery blood flow velocity and transient hyperemic response. Anesth Analg 1999 89 : 170 174.
56. Harrison JM, Girling KJ, Mahajan RP. Effects of propofol and nitrous oxide on middle cerebral artery flow velocity and cerebral autoregulation. Anaesthesia 2002 57 : 27 32.
57. Wilson-Smith E, Karsli C, Luginbuehl IA et al. The effect of nitrous oxide on cerebral blood flow velocity in children anesthetized with propofol. Acta Anaesthesiol Scand 2003 47 : 307 311.
58. Matta BF, Lam AM. Nitrous oxide increases cerebral blood flow velocity during pharmacologically induced EEG silence in humans. J Neurosurg Anesthesiol 1995 7 : 89 93.
59. Becker GL, Pelligrino DA, Miletich DJ et al. The effects of nitrous oxide on oxygen consumption by isolated cerebral cortex mitochondria. Anesth Analg 1986 65 : 355 359.
60. Nakanishi O, Ishikawa T, Imamura Y et al. Inhibition of cerebral metabolic and circulatory responses to nitrous oxide by 6-hydroxydopamine in dogs. Can J Anaesth 1997 44 : 1008 1013.
61. Fukuhara N, Ishikawa T, Kinoshita H et al. Central noradrenergic mediation of nitrous oxide-induced analgesia in rats. Can J Anaesth 1998 45 : 1123 1129.
62. Pelligrino DA, Miletich DJ, Hoffman WE et al. Nitrous oxide markedly increases cerebral cortical metabolic rate and blood flow in the goat. Anesthesiology 1984 60 : 405 412.
63. Algotsson L, Messeter K, Rosen I et al. Effects of nitrous oxide on cerebral haemodynamics and metabolism during isoflurane anaesthesia in man. Acta Anaesthesiol Scand 1992 36 : 46 52.
64. Roald OK, Forsman M, Heier MS et al. Cerebral effects of nitrous oxide when added to low and high concentrations of isoflurane in the dog. Anesth Analg 1991 72 : 75 79.
65. Kaisti KK, Langsjo JW, Aalto S et al. Effects of sevoflurane, propofol, and adjunct nitrous oxide on regional cerebral blood flow, oxygen consumption, and blood volume in humans. Anesthesiology 2003 99 : 603 613.
66. Hormann C, Schmidauer C, Haring HP et al. Hyperventilation reverses the nitrous oxide-induced increase in cerebral blood flow velocity in human volunteers. Br J Anaesth 1995 74 : 616 618.
67. Aono M, Sato J, Nishino T. Nitrous oxide increases normocapnic cerebral blood flow velocity but does not affect the dynamic cerebrovascular response to step changes in end-tidal P(CO2) in humans. Anesth Analg 1999 89 : 684 689.
68. Inaba S, Sato J, Aono M et al. Combined effects of nitrous oxide and propofol on the dynamic cerebrovascular response to step changes in end-tidal PCO2 in humans. Anesthesiology 2003 98 : 633 638.
69. Reinstrup P, Ryding E, Ohlsson T et al. Cerebral blood volume (CBV) in humans during normo- and hypocapnia: influence of nitrous oxide (N(2)O). Anesthesiology 2001 95 : 1079 1082.
70. Karsli C, Wilson-Smith E, Luginbuehl I et al. The effect of nitrous oxide on cerebrovascular reactivity to carbon dioxide in children during propofol anesthesia. Anesth Analg 2003 97 : 694 698.
71. Wilson-Smith E, Karsli C, Luginbuehl I et al. Effect of nitrous oxide on cerebrovascular reactivity to carbon dioxide in children during sevoflurane anaesthesia. Br J Anaesth 2003 91 : 190 195.
72. Girling KJ, Cavill G, Mahajan RP. The effects of nitrous oxide and oxygen on transient hyperemic response in human volunteers. Anesth Analg 1999 89 : 175 180.
73. Iacopino DG, Conti A, Battaglia C et al. Transcranial Doppler ultrasound study of the effects of nitrous oxide on cerebral autoregulation during neurosurgical anesthesia: a randomized controlled trial. J Neurosurg 2003 99 : 58 64.
74. Sakabe T, Nakakimura K. Effects of anesthetic agents and other drugs on cerebral blood flow, metabolism and intracranial pressure. In : Cottrell JE, Smith DS, eds. Anesthesia in Neurosurgery, 4th edn. St Louis : Mosby, 2001 : pp. 129 144.
75. Paut O, Bissonnette B. Effect of halothane on the cerebral circulation in young children: a hysteresis phenomenon. Anaesthesia 2001 56 : 360 365.
76. Bisonnette B, Leon JE. Cerebrovascular stability during isoflurane anaesthesia in children. Can J Anaesth 1992 39 : 128 134.
77. Matta BF, Mayberg TS, Lam AM. Direct cerebrovasodilatory effects of halothane, isoflurane, and desflurane during propofol-induced isoelectric electroencephalogram in humans. Anesthesiology 1995 83 : 980 985 discussion 927A.
78. Leon JE, Bissonnette B. Cerebrovascular responses to carbon dioxide in children anaesthetized with halothane and isoflurane. Can J Anaesth 1991 38 : 817 825.
79. Drummond JC, Todd MM, Scheller MS et al. A comparison of the direct cerebral vasodilating potencies of halothane and isoflurane in the New Zealand white rabbit. Anesthesiology 1986 65 : 462 467.
80. Hansen TD, Warner DS, Todd MM et al. The role of cerebral metabolism in determining the local cerebral blood flow effects of volatile anesthetics: evidence for persistent flow-metabolism coupling. J Cereb Blood Flow Metab 1989 9 : 323 328.
81. Oshima T, Karasawa F, Okazaki Y et al. Effects of sevoflurane on cerebral blood flow and cerebral metabolic rate of oxygen in human beings: a comparison with isoflurane. Eur J Anaesthesiol 2003 20 : 543 547.
82. Matta BF, Heath KJ, Tipping K et al. Direct cerebral vasodilatory effects of sevoflurane and isoflurane. Anesthesiology 1999 91 : 677 680.
83. Bedforth NM, Hardman JG, Nathanson MH. Cerebral hemodynamic response to the introduction of desflurane: A comparison with sevoflurane. Anesth Analg, 2000 91 : 152 155.
84. Luginbuehl IA, Fredrickson MJ, Karsli C et al. Cerebral blood flow velocity in children anaesthetized with desflurane. Paediatr Anaesth 2003 13 : 496 500.
85. Sponheim S, Skraastad O, Helseth E et al. Effects of 0.5 and 1.0 MAC isoflurane, sevoflurane and desflurane on intracranial and cerebral perfusion pressures in children. Acta Anaesthesiol Scand 2003 47 : 932 938.
86. Fairgrieve R, Rowney DA, Karsli C et al. The effect of sevoflurane on cerebral blood flow velocity in children. Acta Anaesthesiol Scand 2003 47 : 1226 1230.
87. McCulloch TJ, Boesel TW, Lam AM. The effect of hypocapnia on the autoregulation of cerebral blood flow during administration of isoflurane. Anesth Analg 2005 100 : 1463 1467, table of contents.
88. Summors AC, Gupta AK, Matta BF. Dynamic cerebral autoregulation during sevoflurane anesthesia: a comparison with isoflurane. Anesth Analg 1999 88 : 341 345.
89. Gupta S, Heath K, Matta BF. Effect of incremental doses of sevoflurane on cerebral pressure autoregulation in humans. Br J Anaesth 1997 79 : 469 472.
90. Conti A, Iacopino DG, Fodale V et al. Cerebral haemodynamic changes during propofol-remifentanil or sevoflurane anaesthesia: transcranial Doppler study under bispectral index monitoring. Br J Anaesth 2006 97 : 333 339.
91. McCulloch TJ, Visco E, Lam AM. Graded hypercapnia and cerebral autoregulation during sevoflurane or propofol anesthesia. Anesthesiology 2000 93 : 1205 1209.
92. Bedforth NM, Girling KJ, Skinner HJ et al. Effects of desflurane on cerebral autoregulation. Br J Anaesth 2001 87 : 193 197.
93. Rowney DA, Fairgrieve R, Bissonnette B. Cerebrovascular carbon dioxide reactivity in children anaesthetized with sevoflurane. Br J Anaesth 2002 88 : 357 361.
94. Luginbuehl IA, Karsli C, Bissonnette B. Cerebrovascular reactivity to carbon dioxide is preserved during hypocapnia in children anesthetized with 1.0 MAC, but not with 1.5 MAC desflurane. Can J Anaesth 2003 50 : 166 171.
95. Clarkson AN. Anesthetic-mediated protection/preconditioning during cerebral ischemia. Life Sci 2007 80 : 1157 1175.
96. Head BP, Patel P. Anesthetics and brain protection. Curr Opin Anaesthesiol 2007 20 : 395 399.
97. Kitano H, Kirsch JR, Hurn PD et al. Inhalational anesthetics as neuroprotectants or chemical preconditioning agents in ischemic brain. J Cereb Blood Flow Metab 2007 27 : 1108 1128.
98. Barlow R, Karsli C, Luginbuehl I et al. Desflurane increases cerebral blood flow velocity when used for rapid emergence from propofol anesthesia in children. Can J Anaesth 2004 51 : 824 828.
99. Amakawa K, Adachi N, Liu K et al. Effects of pre- and postischemic administration of thiopental on transmitter amino acid release and histologic outcome in gerbils. Anesthesiology 1996 85 : 1422 1430.
100. Zhan RZ, Fujiwara N, Endoh H et al. Thiopental inhibits increases in [Ca2+]I induced by membrane depolarization, NMDA receptor activation, and ischemia in rat hippocampal and cortical slices. Anesthesiology 1998 89 : 456 466.
101. Shibuta S, Kosaka J, Mashimo T et al. Nitric oxide-induced cytotoxicity attenuation by thiopentone sodium but not pentobarbitone sodium in primary brain cultures. Br J Pharmacol 1998 124 : 804 810.
102. Nussmeier NA, Arlund C, Slogoff S. Neuropsychiatric complications after cardiopulmonary bypass: cerebral protection by a barbiturate. Anesthesiology 1986 64 : 165 170.
103. Nehls DG, Todd MM, Spetzler RF et al. A comparison of the cerebral protective effects of isoflurane and barbiturates during temporary focal ischemia in primates. Anesthesiology 1987 66 : 453 464.
104. Smith AL, Marque JJ. Anesthetics and cerebral edema. Anesthesiology 1976 45 : 64 72.
105. Karsli C, Luginbuehl I, Farrar M et al. Propofol decreases cerebral blood flow velocity in anesthetized children. Can J Anaesth 2002 49 : 830 834.
106. Vandesteene A, Trempont V, Engelman E et al. Effect of propofol on cerebral blood flow and metabolism in man. Anaesthesia 1988 43 (Suppl 42 43.
107. Engelhard K, Werner C, Eberspacher E et al. Influence of propofol on neuronal damage and apoptotic factors after incomplete cerebral ischemia and reperfusion in rats: a long-term observation. Anesthesiology 2004 101 : 912 917.
108. Bayona NA, Gelb AW, Jiang Z et al. Propofol neuroprotection in cerebral ischemia and its effects on low-molecular-weight antioxidants and skilled motor tasks. Anesthesiology 2004 100 : 1151 1159.
109. Ergun R, Akdemir G, Sen S et al. Neuroprotective effects of propofol following global cerebral ischemia in rats. Neurosurg Rev 2002 25 : 95 98.
110. Sasaki R, Hirota K, Roth SH et al. Anoxic depolarization of rat hippocampal slices is prevented by thiopental but not by propofol or isoflurane. Br J Anaesth 2005 94 : 486 491.
111. Matta BF, Lam AM, Strebel S et al. Cerebral pressure autoregulation and carbon dioxide reactivity during propofol-induced EEG suppression. Br J Anaesth 1995 74 : 159 163.
112. Karsli C, Luginbuehl I, Farrar M et al. Cerebrovascular carbon dioxide reactivity in children anaesthetized with propofol. Paediatr Anaesth 2003 13 : 26 31.
113. Karsli C, Luginbuehl I, Bissonnette B. The cerebrovascular response to hypocapnia in children receiving propofol. Anesth Analg 2004 99 : 1049 1052, table of contents.
114. Moss E, Powell D, Gibson RM et al. Effect of etomidate on intracranial pressure and cerebral perfusion pressure. Br J Anaesth 1979 51 : 347 352.
115. Batjer HH. Cerebral protective effects of etomidate: experimental and clinical aspects. Cerebrovasc Brain Metab Rev 1993 5 : 17 32.
116. Renou AM, Vernhiet J, Macrez P et al. Cerebral blood flow and metabolism during etomidate anaesthesia in man. Br J Anaesth 1978 50 : 1047 1051.
117. Batjer HH, Frankfurt AI, Purdy PD et al. Use of etomidate, temporary arterial occlusion, and intraoperative angiography in surgical treatment of large and giant cerebral aneurysms. J Neurosurg 1988 68 : 234 240.
118. Rosenwasser RH, Jimenez DF, Wending WW et al. Routine use of etomidate and temporary vessel occlusion during aneurysm surgery. Neurol Res 1991 13 : 224 228.
119. Robertson SC, Brown P 3rd., Loftus CM. Effects of etomidate administration on cerebral collateral flow. Neurosurgery 1998 43 : 317 323.
120. Drummond JC, Cole DJ, Patel PM et al. Focal cerebral ischemia during anesthesia with etomidate, isoflurane, or thiopental: a comparison of the extent of cerebral injury. Neurosurgery 1995 37 : 742 748.
121. Milde LN, Milde JH, Michenfelder JD. Cerebral functional, metabolic, and hemodynamic effects of etomidate in dogs. Anesthesiology 1985 63 : 371 377.
122. Hoffman WE, Charbel FT, Edelman G et al. Comparison of the effect of etomidate and desflurane on brain tissue gases and pH during prolonged middle cerebral artery occlusion. Anesthesiology 1998 88 : 1188 1194.
123. Edelman GJ, Hoffman WE, Charbel FT. Cerebral hypoxia after etomidate administration and temporary cerebral artery occlusion. Anesth Analg 1997 85 : 821 825.
124. Drummond JC, McKay LD, Cole DJ, et al. The role of nitric oxide synthase inhibition in the adverse effects of etomidate in the setting of focal cerebral ischemia in rats. Anesth Analg 2005 100 : 841 846, table of contents.
125. Wagner RL, White PF, Kan PB et al. Inhibition of adrenal steroidogenesis by the anesthetic etomidate. N Engl J Med 1984 310 : 1415 1421.
126. Church J, Zeman S, Lodge D. The neuroprotective action of ketamine and MK-801 after transient cerebral ischemia in rats. Anesthesiology 1988 69 : 702 709.
127. Hoffman WE, Pelligrino D, Werner C et al. Ketamine decreases plasma catecholamines and improves outcome from incomplete cerebral ischemia in rats. Anesthesiology 1992 76 : 755 762.
128. Himmelseher S, Pfenninger E, Georgieff M. The effects of ketamine-isomers on neuronal injury and regeneration in rat hippocampal neurons. Anesth Analg 1996 83 : 505 512.
129. Basagan-Mogol E, Buyukuysal RL, Korfali G. Effects of ketamine and thiopental on ischemia reoxygenation-induced LDH leakage and amino acid release from rat striatal slices. J Neurosurg Anesthesiol 2005 17 : 20 26.
130. Shibuta S, Varathan S, Mashimo T. Ketamine and thiopental sodium: individual and combined neuroprotective effects on cortical cultures exposed to NMDA or nitric oxide. Br J Anaesth 2006 97 : 517 524.
131. Langsjo JW, Kaisti KK, Aalto S et al. Effects of subanesthetic doses of ketamine on regional cerebral blood flow, oxygen consumption, and blood volume in humans. Anesthesiology 2003 99 : 614 623.
132. Langsjo JW, Maksimow A, Salmi E et al. S-ketamine anesthesia increases cerebral blood flow in excess of the metabolic needs in humans. Anesthesiology 2005 103 : 258 268.
133. Nagels W, Demeyere R, Van Hemelrijck J et al. Evaluation of the neuroprotective effects of S(+)-ketamine during open-heart surgery. Anesth Analg 2004 98 : 1595 1603.
134. Veselis RA, Reinsel RA, Beattie BJ et al. Midazolam changes cerebral blood flow in discrete brain regions: an H2(15)O positron emission tomography study. Anesthesiology 1997 87 : 1106 1117.
135. Mathew RJ, Wilson WH, Daniel DG. The effect of nonsedating doses of diazepam on regional cerebral blood flow. Biol Psychiatry 1985 20 : 1109 1116.
136. Forster A, Juge O, Morel D. Effects of midazolam on cerebral blood flow in human volunteers. Anesthesiology 1982 56 : 453 455.
137. Forster A, Juge O, Morel D. Effects of midazolam on cerebral hemodynamics and cerebral vasomotor responsiveness to carbon dioxide. J Cereb Blood Flow Metab 1983 3 : 246 249.
138. Matthew E, Andreason P, Pettigrew K et al. Benzodiazepine receptors mediate regional blood flow changes in the living human brain. Proceedings of the National Academy of Sciences of the United States of America 1995 92 : 2775 2779.
139. Knudsen L, Cold GE, Holdgard HO et al. The effects of midazolam on cerebral blood flow and oxygen consumption Interaction with nitrous oxide in patients undergoing craniotomy for supratentorial cerebral tumours. Anaesthesia 1990 45 : 1016 1019.
140. Volkow ND, Wang GJ, Hitzemann R et al. Depression of thalamic metabolism by lorazepam is associated with sleepiness. Neuropsychopharmacology 1995 12 : 123 132.
141. Wolf J, Friberg L, Jensen J et al. The effect of the benzodiazepine antagonist flumazenil on regional cerebral blood flow in human volunteers. Acta Anaesthesiol Scand 1990 34 : 628 631.
142. Forster A, Juge O, Louis M et al. Effects of a specific benzodiazepine antagonist (RO 15-1788) on cerebral blood flow. Anesth Analg 1987 66 : 309 313.
143. Chiolero RL, Ravussin P, Anderes JP et al. The effects of midazolam reversal by RO 15-1788 on cerebral perfusion pressure in patients with severe head injury. Intensive Care Med 1988 14 : 196 200.
144. Knudsen L, Cold GE, Holdgard HO et al. Effects of flumazenil on cerebral blood flow and oxygen consumption after midazolam anaesthesia for craniotomy. Br J Anaesth 1991 67 : 277 280.
145. Harte GJ, Gray PH, Lee TC et al. Haemodynamic responses and population pharmacokinetics of midazolam following administration to ventilated, preterm neonates. J Paediatr Child Health 1997 33 : 335 338.
146. Jorch G, Rabe H, Rickers E et al. Cerebral blood flow velocity assessed by Doppler technique after intravenous application of diazepam in very low birth weight infants. Dev Pharmacol Ther 1989 14 : 102 107.
147. Van Alfen-van der Velden AA, Hopman JC, Klaessens JH, et al. Effects of midazolam and morphine on cerebral oxygenation and hemodynamics in ventilated premature infants. Biol Neonate 2006 90 : 197 202.
148. Abdallah C, Karsli C, Bissonnette B. Fentanyl is more effective than remifentanil at preventing increases in cerebral blood flow velocity during intubation in children. Can J Anaesth 2002 49 : 1070 1075.
149. Glass PS, Gan TJ, Howell S. A review of the pharmacokinetics and pharmacodynamics of remifentanil. Anesth Analg 1999 89 : S7 14.
150. Guy J, Hindman BJ, Baker KZ et al. Comparison of remifentanil and fentanyl in patients undergoing craniotomy for supratentorial space-occupying lesions. Anesthesiology 1997 86 : 514 524.
151. Klimscha W, Ullrich R, Nasel C et al. High-dose remifentanil does not impair cerebrovascular carbon dioxide reactivity in healthy male volunteers. Anesthesiology 2003 99 : 834 840.