Cerebral autoregulation and anesthesia

Dagal, Armagan; Lam, Arthur M.

doi:10.1097/aco.0b013e32833020be

Cited by 127 publications

(98 citation statements)

References 49 publications

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“…As with dopamine, at low doses of epinephrine, there was evidence of impaired CBF autoregulation and an increase in renal and mesenteric BF and cardiac output (17). However, CBF autoregulation was not completely abolished because CrSO 2 did not mirror the fluctuations in BP, whereas CCA BF did.…”

Section: Discussionmentioning

confidence: 94%

“…This finding is explained by the anesthesia-induced impairment of this protective vascular mechanism (17). The increase in CCA BF out of proportion of the increase in BP and CrSO 2 at low to medium doses suggests an increase in cardiac output and, perhaps, a selective dopaminergic vasodilation in the extracranial vessels of the neck and head (4).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Dose-Dependent Hemodynamic and Metabolic Effects of Vasoactive Medications in Normotensive, Anesthetized Neonatal Piglets

Nachar

Booth²,

Friedlich

et al. 2011

Pediatr Res

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ABSTRACT:The developmentally regulated hemodynamic effects of vasoactive medications have not been well characterized. We used traditional and near-infrared spectroscopy monitoring technologies and investigated the changes in heart rate, blood pressure, common carotid artery (CCA) blood flow (BF), cerebral, renal, intestinal, and muscle regional tissue O 2 saturation, and acid-base and electrolyte status in response to escalating doses of vasoactive medications in normotensive anesthetized neonatal piglets. We used regional tissue O 2 saturation and CCA BF as surrogates of organ and systemic BF, respectively, and controlled minute ventilation and oxygenation. Low to medium doses of dopamine, epinephrine, dobutamine, and norepinephrine increased blood pressure and systemic and regional BF in a drug-specific manner, whereas milrinone exerted minimal effects. At higher doses, dopamine, epinephrine, and norepinephrine but not dobutamine decreased systemic, renal, intestinal, and muscle BF, while cerebral BF remained unchanged. Epinephrine induced significant increases in muscle BF and serum glucose and lactate concentrations. The findings reveal novel drug-and dose-specific differences in the hemodynamic response to escalating doses of vasoactive medications in the neonatal cardiovascular system and provide information for future clinical studies investigating the use of vasoactive medications for the treatment of neonatal cardiovascular compromise. (Pediatr Res 70: 473-479, 2011) C ardiovascular compromise is a frequently encountered condition in the critically ill preterm and term infant (1) resulting in inadequate tissue O 2 delivery, impaired cerebral blood flow (CBF) autoregulation, and, potentially, end-organ injury and death (1-3). Our limited ability to accurately monitor changes in neonatal hemodynamics curtails timely recognition, and thus treatment, of neonatal shock.Although vasopressor-inotropes, inotropes, and lusitropes have been used to manage neonatal cardiovascular compromise with an attempt to tailor the treatment to the suspected primary etiology (1), there is only limited information available on the safety and effectiveness of these medications (1,4) and little is known about their developmentally regulated dose-dependent hemodynamic actions (4,5). Recent advances in bedside hemodynamic monitoring techniques using, among others, near-infrared spectroscopy (NIRS) have made continuous, noninvasive monitoring of tissue O 2 delivery (6) possible. Accordingly, data on tissue O 2 delivery and utilization (7) and regional O 2 saturation in critically ill adults, children, and, more recently, neonates have become available (2,3,8 -10).To gain insight into the specific, drug-related changes in neonatal hemodynamics, we used traditional and NIRS hemodynamic monitoring technologies and investigated the changes in heart rate, blood pressure (BP), common carotid artery (CCA) blood flow (BF), cerebral regional tissue O 2 saturation (CrSO 2 ), renal (kidney) regional tissue O 2 saturation (KrSO 2 ), intestina...

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Dose-Dependent Hemodynamic and Metabolic Effects of Vasoactive Medications in Normotensive, Anesthetized Neonatal Piglets

Nachar

Booth²,

Friedlich

et al. 2011

Pediatr Res

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“…Propofol permits better cerebral autoregulation than most other anaesthetic agents. 43 However, propofol decreases CBF and may thereby also affect the kinetics of some PET tracers. 27 Isoflurane and halothane are used increasingly in PET neuroimaging, mainly because they allow good control of the length and depth of anaesthesia.…”

Section: Cbf and Cerebral Blood Volumementioning

confidence: 99%

Anaesthesia for positron emission tomography scanning of animal brains

Alstrup

Smith

2013

Lab Anim

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Positron emission tomography (PET) provides a means of studying physiological and pharmacological processes as they occur in the living brain. Mice, rats, dogs, cats, pigs and non-human primates are often used in studies using PET. They are commonly anaesthetized with ketamine, propofol or isoflurane in order to prevent them from moving during the imaging procedure. The use of anaesthesia in PET studies suffers, however, from the drawback of possibly altering central neuromolecular mechanisms. As a result, PET findings obtained in anaesthetized animals may fail to correctly represent normal properties of the awake brain. Here, we review findings of PET studies carried out either in both awake and anaesthetized animals or in animals given at least two different anaesthetics. Such studies provide a means of estimating the extent to which anaesthesia affects the outcome of PET neuroimaging in animals. While no final conclusion can be drawn concerning the 'best' general anaesthetic for PET neuroimaging in laboratory animals, such studies provide findings that can enhance an understanding of neurobiological mechanisms in the living brain. A new era of neuroscience began with the invention of positron emission tomography (PET) for studying processes as they occur in the living brain.1 -4 PET makes use of the radioactive decay of positron-emitting nuclides to derive an image of physiological and pharmacological events in a living organ such as the brain. PET is currently the primary procedure for studying molecular events in realtime in intact animals and humans. PET scanning can be used in all branches of pharmacology, molecular biology and medicine, including neuroscience, cancer research and cardiovascular biology. 5 -7

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“…In a conscious, healthy individuals, the cerebral blood flow is maintained at a constant level of between 50 (recently 70 has been proposed) and 150 mmHg, despite changes in the cerebral perfusion pressure [11] [18]. Reports indicate that cerebral autoregulation is unaffected by general anesthesia [18]. In our patient population, the mABP at the level of the brain was between 54 and 87 mmHg and safe mABP levels could be maintained.…”

Section: Discussionmentioning

confidence: 52%

“…This calculated value was the same as the value that was directly recorded in the radial artery in our study (approximately 81 mmHg). In a conscious, healthy individuals, the cerebral blood flow is maintained at a constant level of between 50 (recently 70 has been proposed) and 150 mmHg, despite changes in the cerebral perfusion pressure [11] [18]. Reports indicate that cerebral autoregulation is unaffected by general anesthesia [18].…”

Section: Discussionmentioning

confidence: 99%

The Cardiac Function in the Beach Chair Position under General Anesthesia

Tanabe¹,

Yamada²,

Nagase³

et al. 2018

OJAnes

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Background: Shoulder surgery is performed in the beach chair position (BCP). The systemic arterial blood pressure (BP) must be increased to prevent cerebral hypoperfusion. However, it is not clear how the cardiac function is affected when BP increase to maintain cerebral perfusion pressure in anesthetized patients. Methods: An analysis was performed using the data from 13 patients. We prepared a parallel circuit using a FloTrac Sensor transducer and an arterial BP transducer. Following the transfer of the patient to the BCP under general anesthesia, the FloTrac Sensor transducer was placed at the level of the fourth intercostal space, the arterial BP transducer was placed at the external auditory meatus level. We selected two points before surgery (120 s apart), during which the mean arterial BP (mABP) at the level of the brain was stable and at which the values in the supine position and the BCP were within 5 mmHg. Results: While the patients were in the supine position, the mean mABP at the mid-axillary level was 65.7 mmHg. In the BCP, the mean mABP was 66.5 mmHg at the external auditory meatus and 80.7 mmHg at the fourth intercostal space. The cardiac index changed from 2.2 (supine position) to 2.5 l/min/m 2 (BCP). The stroke volume index was significantly increased from 35.8 to 42.3 ml/m 2 (P = 0.003). The heart rate changed from 63.0 to 58.6 beats/min. The stroke volume variation was significantly decreased from 12.4% to 8.8% (P = 0.024). Conclusion: In order to ensure patient safety, close attention should be paid to the systemic cardiovascular changes that occur when the BP is increased.

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Cerebral autoregulation and anesthesia

Abstract: Intraoperative cerebral autoregulation monitoring is an important consideration for the patients with neurologic disease. Transcranial Doppler based static autoregulation measurements appears to be the most robust bedside method for this purpose.

Cited by 127 publications

References 49 publications

Dose-Dependent Hemodynamic and Metabolic Effects of Vasoactive Medications in Normotensive, Anesthetized Neonatal Piglets

Dose-Dependent Hemodynamic and Metabolic Effects of Vasoactive Medications in Normotensive, Anesthetized Neonatal Piglets

Anaesthesia for positron emission tomography scanning of animal brains

The Cardiac Function in the Beach Chair Position under General Anesthesia

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