Effects of moderate and severe hypocapnia on intracerebral perfusion and brain tissue oxygenation in piglets

• Published in: Pediatric anesthesia Vol. 29; no. 11; pp. 1114 - 1121
• Main Authors: Ringer, Simone K., Clausen, Nicola G., Spielmann, Nelly, Weiss, Markus
• Format: Journal Article
• Language: English
• Published: France Wiley Subscription Services, Inc 01.11.2019
• Subjects: anesthesia; cerebral circulation; hypocapnia; inhalation; intraoperative neurophysiological; monitoring; pigs; vascular hypotension; vascular hypotension; inhalation; pigs; hypocapnia; intraoperative neurophysiological; monitoring; cerebral circulation; anesthesia
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1111/pan.13736

Background Hypocapnia is a common alteration during anesthesia in neonates. Aim To investigate the effects of hypocapnia and hypocapnia combined with hypotension (HCT) on cerebral perfusion and tissue oxygenation in anesthetized piglets. Method Thirty anesthetized piglets were randomly allocated to groups: moderate hypocapnia (mHC), severe hypocapnia (sHC), and HCT. Cerebral monitoring comprised a tissue oxygen partial pressure and a laser Doppler probe inserted into the brain tissue as well as a near‐infrared spectroscopy (NIRS) sensor placed on the skin, measuring regional oxygen saturation. Hypocapnia was induced by hyperventilation (target PaCO2 mHC: 3.7‐4; sHC: 3.1‐3.3 kPa) and hypotension by blood withdrawal and nitroprusside infusion (mean blood pressure: 35‐38 mm Hg). Data were analyzed at baseline, during (Tr20, Tr40, Tr60) and after (Post20, Post40, Post60) treatment. Results Compared to baseline, tissue oxygen partial pressure decreased significantly and equally during all treatments (mean [SD] at baseline: mHC 35.7 [32.45]; sHC: 28.1 [20.24]; HCT 25.4 [10.3] and at Tr60: mHC: 29.9 [27.36]; sHC: 22.2 [18.37]; HCT: 18.4 [9.5] mm Hg). Decreased laser Doppler flow was detected with all treatments at Tr20 (mHC: 0.9 [0.18]; sHC: 0.88 [0.15]; HCT: 0.97 [0.13] proportion from baseline). Independently of group, regional oxygen saturation varied only after reverting and not during treatment. Blood lactate, pH, HCO3−, and PaO2 increased during treatment with no differences between groups. Conclusion This animal model revealed reduced cerebral blood flow and brain tissue oxygenation during hypocapnia without detectable changes in regional oxygen saturation as measured by NIRS. Changes occurred as early as during moderate hypocapnia.