Central nervous system effects

All inhalational anesthetics are cerebral vasodilators tending to increase cerebral blood flow and thus intracranial pressure. However, there is no change in cerebral blood flow in normocapnic normotensive volunteers given less than 1 MAC of isoflurane, and isoflurane does not increase the production or prevent the absorption of cerebrospinal fluid. Autoregulation of cerebral blood flow is retained with low doses of isoflurane, and a decrease in PaCO2 produces a nearly proportional decrease in cerebral blood flow. Isoflurane causes a dose-related decrease in cerebral oxygen consumption up to 1 MAC while maintaining a normal cerebral energy state. This may account for the reports that isoflurane provides more protection from brain ischemia than other agents and has become the agent of choice for neuroanesthesia.

Although isoflurane has been shown to lower intracranial pressure in patients with cerebral disease, some animal studies have shown that it rises in the presence of acute head injury when isoflurane is administered. Under conditions of controlled ventilation and low sedative doses isoflurane is unlikely to increase intracranial pressure, but the effect of isoflurane sedation in patients with head injury is still uncertain.

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