Date of Award

January 2012

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Ramachandran Ramani

Subject Area(s)

Medicine

Abstract

ALTERATIONS IN REGIONAL CEREBRAL BLOOD FLOW WITH PROPOFOL ANESTHESIA COMPARED WITH SEVOFLURANE. Tejas Manchandia, Maolin Qiu, Margaret Rose, Todd Constable, and Ramachandran Ramani. Department of Anesthesiology and Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT.

Alterations in regional cerebral blood flow (rCBF) are a reflection of neuronal activity in the brain because of the property of flow-metabolism coupling. Our group has previously reported a non-uniformity in rCBF changes with 0.25 MAC sevoflurane. The purpose of this project was to measure the alteration in rCBF with 0.5 MAC equivalent propofol and compare the changes in rCBF with those observed previously with sevoflurane. We hypothesize that sevoflurane and propofol produce spatially non-uniform changes in rCBF, with significant decreases in the thalamus and prefrontal cortex. The study protocol was approved by the Yale University Human Investigation Committee (HIC). The subjects were 30 healthy volunteers (19-35 years old). Propofol was administered through a target controlled infusion (TCI) device to a target plasma concentration of 2 μg/mL (0.5 MAC equivalent). Propofol level was confirmed by drawing a blood sample at the beginning and end of the infusion period. Regional CBF was measured in a 3 Tesla Siemens Trio scanner using the pulsed arterial spin labeling (PASL) technique. CBF was measured in the subjects while awake and under anesthesia, and the difference was calculated (δCBF). With 2 μg/mL plasma level propofol, there was a drop in rCBF in several areas of the frontal, parietal, occipital, and temporal cortices as well as the

thalamus. Clinically, all the subjects were asleep and had no memory of the event. A modest rise in rCBF was seen in the anterior cingulate, insula, and parahippocampal gyrus. Our results support our hypothesis that propofol causes a non-uniformity in rCBF, which was observed with sevoflurane as well.

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