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BJA Advance Access published online on March 15, 2008
British Journal of Anaesthesia, doi:10.1093/bja/aen036
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Positron emission tomography study of regional cerebral blood flow and flow–metabolism coupling during general anaesthesia with xenon in humans {dagger}

S. Rex1,*,{ddagger}, P. T. Meyer2,{ddagger}, J.-H. Baumert3, R. Rossaint1, M. Fries1, U. Büll2 and W. M. Schaefer2

1 Department of Anaesthesiology
2 Department of Nuclear Medicine, University Hospital, Technical University Aachen, Aachen, Germany
3 UMC St Radboud, Nijmegen, The Netherlands

* Corresponding author: Klinik für Anästhesiologie und Fachübergreifende Klinik Operative Intensivmedizin Erwachsene, Universitätsklinikum der RWTH Aachen, Pauwelsstr. 30, D-52074 Aachen, Germany. E-mail: srex{at}ukaachen.de

Background: The effects of xenon on regional cerebral blood flow (rCBF) are controversial. Moreover, the precise sites of action at which xenon exerts its effects in the human brain remain to be established.

Methods: rCBF was sequentially assessed by H215O positron emission tomography in six volunteers. rCBF was determined at baseline and during general anaesthesia induced with propofol and maintained with one minimum alveolar concentration xenon. rCBF measurements were started after the calculated plasma concentration of propofol had decreased to subanaesthetic levels (<1.0 µg ml–1). Changes in rCBF were calculated for 13 cerebral volumes of interest by measurement of a semi-quantitative perfusion index (PI). In addition, voxel-wise changes in rCBF were analysed using statistical parametric mapping.

Results: Xenon had only minor effects on PI in grey matter volumes of interest. In contrast, PI was increased in white matter [from 1.01 (0.11) to 1.24 (0.15) kcnt ml–1 MBq–1, P=0.05, mean (SD)]. Voxel-based analysis showed an increase of rCBF in white matter and a relative decrease of rCBF during xenon anaesthesia in distinct grey matter regions, particularly the orbito- and mesiofrontal cortex, cingulate gyrus, thalamus, hippocampus and bilateral cerebellum (P<0.05 corrected). When correlating PI with cerebral metabolic rate of glucose (previously obtained in another group of six volunteers using 18F-fluorodeoxyglucose as tracer), the flow–metabolism coupling was preserved during xenon anaesthesia.

Conclusions: Xenon exerted distinct regional effects on CBF: relative decreases in several cortical, subcortical, and cerebellar areas were accompanied by an increase in white matter. Flow–metabolism coupling was not impaired during xenon anaesthesia.

Keywords: anaesthetics gases; brain, blood flow; brain, metabolism; neurophysiology; special drugs, xenon

{dagger} Declaration of Interest. The Department of Anaesthesiology has received funding from Messer-Griesheim GmbH, Business Unit Messer Medical, Krefeld, Germany.

{ddagger} S. Rex and P. T. Meyers contributed equally to this study.


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