Changes of angiotensin Ⅱ and endothelin levels under the cerebral protection of desfiurane during the clamp operation of intracranial aneurysm at various time points

Tao WANG; Fang LUO; Jizong ZHAO; Shuzhen ZHANG

ABSTRACT

BACKGROUND:

Cerebral vascular spasm is the main complication of intracranial aneurysm during perioperative period. Anesthesia of clamp operation of intracranial aneurysm not only meet the basic requirement of anesthesia, but also prevent cerebral vascular spasm and protect cerebral function possibly.

OBJECTIVE:

To observe the changes of angiotensin Ⅱ and endothelins of paitents with intracranial aneurysm under the anesthesia of desflurane during the clamp operation so as to discuss the effect of desflurane on cerebral protection.

DESIGN:

Case analysis.

SETTING:

Department of Neurosurgery and Department of Anesthesiology of Beijing Tiantan Hospital Affiliated to Capital University of Medical Sciences.

PARTICIPANTS:

Totally 64 patients, 30 males and 34 females, who were prepared for clamp operation of intracranial aneurysm, were selected from Department of Neurosurgery of Beijing Tiantan Hospital Affiliated to Capital University of Medical Sciences between October 2002 and June 2004.

METHODS:

After anesthesia induction, tracheal cannula was used to control respiration and desflurane was used to maintain the anesthesia. Totally 4 mL arterial blood were collected at the four time points before anesthesia induction, cutting dura mater, clamp aneurysm and 30 minutes after clamp aneurysm. Levels of angiotensin Ⅱ and endothelins in plasma were assayed with radioimmunoassay.MAIN OUTCOME

MEASURES:

Levels of angiotensin Ⅱ and endothelins at the four time points before anesthesia induction, cutting dura mater,clamp aneurysm and 30 minutes after clamp aneurysm.

RESULTS:

Aneurysm of two patients was disrupted during the operation of angiotensin Ⅱ was ranged normally before operation, and that at the other three time points during the anesthesia of desflurane did not changed endothelins Level of endothelins at the three time points of cutting dura mater, clamp aneurysm and 30-minutes after clamp aneurysm was lower than that at the time point of pre-an esthesia induction [(40.4±10.3),(40.0±9.6), (40.7±12.3), (49.3±12.7) ng/L, (P=0.002, 0.001, 0.009)].

CONCLUSION:

Levels of angiotensin Ⅱ and endothelins which anesthetizes by desflurane are not increased during the whole clamp operation of intracranial aneurysm. However, level of endothelins is obviously lower than that at the time point of pre-anesthesia induction, and there is not significantly different from that at various time points of the operation. This suggests that anesthesia of desflurane can avoid the onset of acute cerebral vascular spasm induced by the increasing liberation of angiotensin Ⅱ and endothelins and decrease the onset of secondary cerebral ischemic injury so as to protect brain.