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Cerebrovascular CO2 reactivity during isoflurane-nitrous oxide anesthesia in patients with chronic renal failure

  • Original Article
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A Correction to this article was published on 23 December 2017

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Abstract

Purpose

We assessed the cerebrovascular CO2 reactivity (CO2R) in chronic renal failure (CRF) patients without diabetes mellitus (DM), uncontrolled hypertension, peripheral vascular disease, or neurological disease under isoflurane-nitrous oxide anesthesia.

Methods

Forty-nine patients undergoing surgery, including 36 CRF patients (30 receiving dialysis and six pre-dialysis patients) and 13 patients without CRF (controls). Middle cerebral artery flow velocity (VMCA) was measured by transcranial Doppler ultrasonography at an end-tidal CO2 of 35 to 45 mmHg. CO2R was calculated as an absolute value (change in VMCA per mmHg PaCO2) and a relative value (absolute CO2R/baseline VMCA × 100). Factors associated with CO2R were evaluated simultaneously.

Results

Despite no significant differences in the absolute and relative values of CO2R between the CRF (mean 2.5 cm/s/mmHg; median 5.0%/mmHg) and control (2.4 cm/s/mmHg; 5.0%/mmHg) groups, blood urea nitrogen (BUN) concentrations in the CRF group correlated inversely with both absolute and relative CO2R. BUN concentration was higher (mean 72 versus 53 mg/dl, p = 0.006) and relative CO2R was lower (mean 2.6 versus 5.7%/mmHg, p = 0.011) in patients with pre-dialysis CRF (n = 6) versus CRF patients receiving dialysis (n = 30).

Conclusions

CO2R in CRF patients was not significantly different from that in controls. However, in CRF patients with high BUN concentrations, CO2R might be impaired, leading to reduced cerebrovascular reserve capacity. Because DM is a major cause of CRF and we excluded DM patients, our results might not be applicable to patients with DM-induced CRF.

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Change history

  • 23 December 2017

    In the original publication of the article, the first sentence was published incorrectly under the section “Patients and preoperative assessment”. The correct sentence should read as, “The Yamaguchi University Graduate School of Medicine Ethics Committee for Human Study approved the study protocol (18th August 2004: H16-71)”.

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Authors and Affiliations

  1. Department of Anesthesiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan

    Kazuyoshi Ishida, Masato Uchida, Kohji Utada, Atsuo Yamashita, Satoshi Yamashita, Shiro Fukuda & Mishiya Matsumoto

  2. Department of Anesthesiology, Yamaguchi Rosai Hospital, 1315-4 Onoda, Sanyoonoda, Yamaguchi, 756-0095, Japan

    Takefumi Sakabe

Authors
  1. Kazuyoshi Ishida
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  2. Masato Uchida
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  3. Kohji Utada
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  4. Atsuo Yamashita
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  5. Satoshi Yamashita
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  7. Mishiya Matsumoto
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  8. Takefumi Sakabe
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Corresponding author

Correspondence to Kazuyoshi Ishida.

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Conflict of interest

This work was supported by a grant from the Ministry of Education, Science, Sports and Culture of Japan (no. 22591734 for Kazuyoshi Ishida).

Additional information

A correction to this article is available online at https://doi.org/10.1007/s00540-017-2443-y.

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Ishida, K., Uchida, M., Utada, K. et al. Cerebrovascular CO2 reactivity during isoflurane-nitrous oxide anesthesia in patients with chronic renal failure. J Anesth 32, 15–22 (2018). https://doi.org/10.1007/s00540-017-2422-3

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  • DOI: https://doi.org/10.1007/s00540-017-2422-3

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