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(Stroke. 2001;32:1920.)
© 2001 American Heart Association, Inc.

Original Contributions

Anesthetic Choice of Halothane Versus Propofol

Impact on Experimental Perioperative Stroke

Anish Bhardwaj, MD; Alejandro F. Castro III, BA; Nabil J. Alkayed, MD, PhD; Patricia D. Hurn, PhD Jeffrey R. Kirsch, MD

From the Departments of Anesthesiology/Critical Care Medicine (A.B., A.F.C., N.J.A., P.D.H., J.R.K.) and Neurology (A.B., J.R.K.), Johns Hopkins University School of Medicine, Baltimore, Md.

Correspondence to Anish Bhardwaj, MD, Neurosciences Critical Care Division, Meyer 8-140, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287. E-mail abhardwa{at}jhmi.edu

Background and Purpose—— It is not known whether preischemic exposure to anesthetic agents affects the amount of damage from transient focal ischemia that occurs after cessation of the anesthetic. We compared the effect of prior exposure to halothane or propofol on infarction size after transient middle cerebral artery occlusion (MCAO) induced in the awakening animal to test the hypothesis that anesthetic type and exposure duration would independently affect the amount of brain injury.

Methods—— Male Wistar rats (weight, 200 to 300 g) were anesthetized briefly with halothane for placement of hemodynamic instrumentation. Twenty-four hours later, rats were treated with either a short (approximately 1 hour) or long (8 hours) duration of inhaled halothane (1% to 2%) or intravenous propofol (10 mg/kg bolus, 30 mg/kg per hour infusion). Each cohort (n=8 per group) was then subjected to 2-hour MCAO by the intraluminal suture technique. All anesthesia was discontinued once MCAO was achieved. Infarct volume was measured at 22 hours of reperfusion. In a second cohort, regional cerebral blood flow (CBF) was measured ([¹⁴C]iodoantipyrine autoradiography) at end-occlusion in short-duration halothane (n=5) or short-duration propofol (n=5) anesthesia groups and in corresponding surgical shams (n=3 each).

Results—— Pericranial temperature, PaO₂, PaCO₂, and blood pressure were controlled and not different among groups before or during occlusion. MCAO resulted in a similar immediate reduction in laser-Doppler flow signal after discontinuation of anesthesia in the awakening animals. Infarct volume was smaller in rats exposed to short-duration halothane in cortex (87.5±16.6 mm³) (mean±SEM) and caudoputamen (38.3±13.7 mm³) compared with rats exposed to short-duration propofol (cortex, 177.5±16.9 mm³; caudoputamen, 47.8±2.9 mm³). Infarct volume was not different in long-duration halothane versus long-duration propofol treatment. Absolute cortical or caudoputamen intraischemic CBF was not different between short-duration halothane or short-duration propofol treatment.

Conclusions—— These data demonstrate that short-duration halothane exposure before MCAO in the awakening animal attenuates infarction volume compared with propofol. This protection by halothane is not mediated through preservation of intraischemic CBF. Longer durations of halothane exposure may activate secondary injury pathways, which negate the protective effects of short-term halothane preischemic treatment.

Key Words: anesthesia • cerebral ischemia • halothane • propofol • stroke

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