British Journal of Anaesthesia, Vol 83, Issue 4 580-584, Copyright © 1999 by The Board of Management and Trustees of the British Journal of Anaesthesia
P. W. Doyle and B. F. Matta
Metabolic suppression may have a role in cerebral protection. It is often
assumed that the cerebral metabolic and protective effects of qualitative
burst suppression are similar to those of the isoelectric encephalogram
(EEG). We have examined the effect of different degrees of EEG suppression
on blood flow and oxygen difference during general anaesthesia. We studied
11 patients undergoing general anaesthesia for resection of acoustic
neuromas. The study was performed after surgery with propofol and
remifentanil anaesthesia. Transcranial Doppler ultrasonography and jugular
bulb venous saturations were measured at values of EEG suppression: 0%, 50%
and 100% (isoelectric EEG). Data from nine patients were suitable for
analysis. There were no significant differences in mean arterial pressure,
heart rate or PaCO2 during EEG activity, 50% burst suppression ratio or
isoelectric EEG. There was a significant decrease in middle cerebral artery
flow velocity (vmca) with increasing EEG suppression (0% suppression, mean
38 (SEM 4) cm s-1; 50% suppression, 29 (3) cm s-1; and 100% suppression, 24
(2) cm s-1; P < 0.05). Jugular bulb venous saturations did not change
consistently with the change in EEG activity, indicating intact
flow-metabolism coupling. We conclude that the degree of EEG suppression
had a significant effect on blood flow. If flow-metabolism coupling is
maintained, the assumption that cerebral metabolism during 50% EEG burst
suppression is equivalent to isoelectric EEG may not be justified. If
cerebral protection is related to brain metabolism, then an isoelectric EEG
may give more cerebral protection than 50% burst suppression.
CLINICAL INVESTIGATIONS
Burst suppression or isoelectric encephalogram for cerebral protection: evidence from metabolic suppression studies
Department of Anaesthesia, Norfolk and Norwich Hospital, Brunswick Road, Norwich NR1 3SR, UK; Department of Anaesthesia, Addenbrooke's Hospital, Box 93, Hills Road, Cambridge CB2 2QQ, UK
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