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BJA Advance Access published online on February 11, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei087
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journal.permissions@oupjournals.org
Accepted September 10, 2004

Clinical Investigation

Sevoflurane effects on retrobulbar arteries blood flow in children{dagger}

T. Geeraerts 1, J.-M. Devys 1*, O. Berges 2, P. Dureau 3, and B. Plaud 1

1 Department of Anaesthesiology, Intensive Care and Emergency, Fondation Ophtalmologique Adolphe de Rothschild, 25-29 rue Manin, F-75940 Paris Cedex 19, France
2 Department of Medical Imaging, Fondation Ophtalmologique Adolphe de Rothschild, 25-29 rue Manin, F-75940 Paris Cedex 19, France
3 Department of Ophthalmology and Ophthalmo-Paediatry, Fondation Ophtalmologique Adolphe de Rothschild, 25-29 rue Manin, F-75940 Paris Cedex 19, France

* To whom correspondence should be addressed.
J.-M. Devys, E-mail: jmdevys{at}fo-rothschild.fr


  Abstract

Background. Measure of blood flow velocity in retrobulbar vessels is performed to determine the severity of ophthalmic pathologies as glaucoma. In children, this measure is usually performed under general anaesthesia. Sevoflurane is known to not modify cerebral blow flow velocities. However, its effect on retrobulbar circulation is not known. This study was designed to evaluate the effect of sevoflurane on retrobulbar circulation flow velocity in children undergoing examination for ocular disorders under general anaesthesia.

Methods. Thirteen mechanically ventilated children (FIO2=1) were included. Blood flow velocities of central retinal artery, ophthalmic artery, and middle cerebral artery were measured by Doppler ultrasound during 1 and 2 age-adjusted minimal alveolar concentration (MAC) sevoflurane anaesthesia. Intra-ocular pressure and non-invasive haemodynamic parameters were also measured. End-tidal carbon dioxide tension was controlled during all the study period.

Results. Mean arterial pressure decreased from 1 to 2 age-adjusted MAC sevoflurane (58 [12] vs 54 [12] mm Hg, P=0.01). In the ophthalmic artery, end diastolic velocity (EDV) decreased significantly at 2 MAC (1 MAC: 4.4 [4] cm s-1 vs 2 MAC: 1.4 [2.4] cm s-1; P=0.04) and resistivity index (RI) increased significantly (1 MAC: 0.83 [0.11] vs 2 MAC: 0.93 [0.09]; P=0.007). Systolic velocity, EDV, and RI remained constant in the central retinal artery and in the middle cerebral artery.

Conclusion. High alveolar concentration of sevoflurane decreased blood flow velocity in the ophthalmic artery, but not in the central retinal and the middle cerebral arteries in children ventilated in hyperoxic condition. This effect was related to a decrease in mean arterial pressure. This vessel-dependant effect may be explained by the different autoregulatory mechanisms of these arteries. In the present hyperoxic conditions, the vascular effect of sevoflurane may have been limited in the central retinal artery and not in the ophthalmic artery.

Keywords: anaesthetics volatile, sevoflurane; blood, flow, velocity; blood, retrobulbar circulation; children.
{dagger} This work was presented in part at the annual meeting congress of the Société Française d'Anesthésie-Réanimation (SFAR), April 17-18, 2004, Paris, France.
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