Minimum cerebral blood flow and metabolism during craniotomy. Effect of thiopental loading

Cerebral blood flow and metabolism were measured repeatedly during surgery for cerebral tumours by a modification of the classical Kety & Schmidt method using 133Xe infusion intravenously. Our standard procedure for neuroanaesthesia (pentobarbitone-fentanyl induction, halothane-nitrous oxide maintenance) reduced blood flow from 47.1 to 24.2 ml X 100 g X ml-1 and metabolism from 3.30 to 1.83 ml O2 X 100 g-1 X ml-1. PaCO2 was reduced by hyperventilation from 5.3 to 3.6 kPa. Additional thiopental loading and maintenance using 4 + 4 mg X kg-1 (n = 5) or 8 + 8 mg X kg-1 (n = 5) reduced cerebral metabolism by an additional 15% (P less than 0.01) and blood flow by 16.5% (P less than 0.01), while mean arterial blood pressure fell from 11.0 to 9.9 kPa (P less than 0.05). PaCO2 remained unchanged. This additional reduction in cerebral metabolism and blood flow is small, but we nevertheless conclude that it may well be of clinical interest to the problem of protecting the brain in case of episodes of focal cerebral ischaemia which may arise peroperatively during intracranial surgery.