Local cerebral blood flow and CO2 reactivity during prostaglandin E1-induced hypotension in patients undergoing cerebral aneurysm surgery.

The effects of prostaglandin E1 (PGE1) on local cerebral blood flow and CO2 reactivity were studied in 30 patients undergoing cerebral aneurysm surgery in eight of whom the aneurysm had not ruptured and was an incidental finding. The aneurysms were clipped at various intervals depending upon clinical conditions. Blood flow on the open brain surface was measured with a thermal gradient blood flow-meter. Hypotension was initially induced with 0.1 microgram kg-1 min-1 of PGE1 and subsequently adjusted to maintain the mean arterial blood pressure at about 70 mmHg. Local cerebral blood flow and CO2 reactivity were studied during and after PGE1 administration. Both were preserved, but CO2 reactivity values were lower in patients in whom the aneurysm had ruptured than in those in whom it had not ruptured. PGE1 may be an appropriate drug with which to induce hypotension during cerebral aneurysm surgery because cerebral blood flow and CO2 reactivity is preserved.