Cerebrovascular carbon dioxide reactivity in children anaesthetized with propofol

Background : Propofol, by virtue of its favourable pharmacokinetic profile, is suitable for maintenance of anaesthesia by continuous infusion during neurosurgical procedures in adults. It is gaining popularity for use in paediatric patients. To determine the effects of propofol on carbon dioxide cerebrovascular reactivity in children, middle cerebral artery blood flow velocity was measured at different levels of endtidal (PECO2) by transcranial Doppler sonography. Methods : Ten ASA I or II children, aged 1-6 years undergoing elective urological surgery were enrolled. Anaesthesia comprized propofol aimed at producing an estimated steady-state serum concentration of 3 mug.ml(-1) and a caudal epidural block. PECO2 was adjusted randomly in an increasing or decreasing fashion between 3.3, 5.2 and 7.2 kPa (25, 40 and 55 mmHg) with an exogenous source of CO2 while maintaining ventilation parameters constant. Results : Cerebral blood flow velocity increased as PECO2 increased from 3.3 to 5.2 kPa (25-40 mmHg) (P<0.001) and from 5.2 to 7.2 kPa (40-55 mmHg) (P<0.001). Mean heart rate and blood pressure did not change significantly. Conclusions : This study demonstrates that cerebrovascular CO2 reactivity is maintained over PECO2 values of 3.3, 5.2 and 7.2 kPa (25, 40 and 55 mmHg) in healthy children anaesthetized with propofol.