Impact of Cardio-Pulmonary and Intraoperative Factors on Occurrence of Cerebral Infarction After Early Surgical Repair of the Ruptured Cerebral Aneurysms

Chong, Jong-Yun; Kim, Dong-Won; Jwa, Cheol-Su; Yi, Hyeong-Joong; Ko, Yong; Kim, Kwang-Myung

doi:10.3340/jkns.2008.43.2.90

Cited by 10 publications

(17 citation statements)

References 19 publications

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“…However, decreasing MAP is still concerning. In our study, we found that decreasing MAP of 32 mmHg or 33.3% from baseline predicted the development of DNID with a sensitivity of 92.9% and specificity of 85.7%, and decreasing SBP from the initial baseline has also been proposed by Chong et al [17]. ey reported Δ SBP of 30 mmHg or 20% from baseline associated with DNID.…”

Section: Discussionsupporting

confidence: 80%

Appropriate Blood Pressure in Cerebral Aneurysm Clipping for Prevention of Delayed Ischemic Neurologic Deficits

Thongrong

Kasemsiri

Duangthongphon

et al. 2020

Anesthesiology Research and Practice

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Background. Delayed ischemic neurologic deficit (DNID) is a problem after cerebral aneurysm clipping. Intraoperative hypotension seems to be indicated as a risk factor, but it remains a controversial issue with varying low-blood pressure levels accepted. Methods. A retrospective, hospital-based, case-control study was performed with patients who received general anesthesia for cerebral aneurysm clipping. 42 medical record charts were randomly selected and matched 1 : 2 (1 case with DNID : 2 controls without DNID) based on the type of general anesthetic techniques and severity of subarachnoid hemorrhage. The optimal cutoff points of hemodynamic response were calculated by the area under the curve. Results. Data suggested that the optimal cutoff points for lowest blood pressure for prevention of DNID should be systolic blood pressure (SBP) of 95 mmHg (sensitivity of 78.6%; specificity of 53.6%), diastolic blood pressure (DBP) of 50 mmHg (sensitivity of 71.4%; specificity of 67.9%), and mean arterial pressure (MAP) of 61.7 mmHg (sensitivity of 85.7%; specificity of 35.7%). Furthermore, the optimal cutoff point mean difference baseline blood pressure was recommended as Δ SBP of 36 mmHg (sensitivity of 85.7%; specificity of 60.7%), Δ DBP of 27 mmHg (sensitivity of 92.9%; specificity of 71.4%), and Δ MAP of 32 mmHg (sensitivity of 92.9%; specificity of 85.7%). No significant difference between DNID and non-DNID groups was found for end-tidal carbon dioxide (ETCO2) and has poor diagnostic value for predicting DNID. Conclusion. To prevent DNID, we recommend that optimal blood pressure should not be lower than 95 for SBP, 50 for DBP, and 61.7 mmHg for MAP. Additionally, we suggest that Δ SBP, Δ DBP, and Δ MAP should be less than 36, 27, and 32 mmHg, respectively.

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Section: Discussionsupporting

confidence: 80%

Appropriate Blood Pressure in Cerebral Aneurysm Clipping for Prevention of Delayed Ischemic Neurologic Deficits

Thongrong

Kasemsiri

Duangthongphon

et al. 2020

Anesthesiology Research and Practice

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“…Other studies have directed attention to operative factors relating to poor outcomes. In a 2008 study, Chong et al 1 focused on intraoperative and perioperative factors contributing to poor clinical outcome and development of cerebral infarction, noting duration of temporary vessel occlusion, intraoperative hypotension, and intraoperative hypoxemia to be independently associated with cerebral infarction at 6 months in a multiple logistic regression analysis. Several studies have also addressed risks associ- ated with use and prolonged duration of temporal vessel occlusion during aneurysm surgery.…”

Section: Significance Of the Perioperative Periodmentioning

confidence: 99%

Acute postoperative neurological deterioration associated with surgery for ruptured intracranial aneurysm: incidence, predictors, and outcomes

Mahaney¹,

Todd²,

Bayman

et al. 2012

JNS

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Neurological injury incurred perioperatively or in the acute postoperative period accounts for a large percentage of poor outcomes in patients with good admission WFNS grades undergoing surgery for aneurysmal SAH. Avoiding surgical factors associated with postoperative neurological deterioration and directing investigative efforts at developing improved neuroprotection for use in aneurysm surgery may significantly improve long-term neurological outcomes in patients with SAH.

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“…First, PaCO 2 and pH rather than ETCO 2 influence the cerebral perfusion. 41 meaning that in the present study, PaCO 2 concentrations may be slightly higher than the reported ETCO 2 values. We might therefore overestimate the effect of hypercapnia, while underestimating the effect of hypocapnia.…”

Section: Strengths and Limitationscontrasting

confidence: 73%

“…Hypercapnia can increase cardiac output and cause a shift in the oxyhemoglobin dissociation curve, resulting in increased tissue perfusion and oxygenation. 41 It has been hypothesized that hypercapnia can prevent surgical site infections, but a randomized trial was unable to confirm this. 42 Also, hypercapnia can increase myocardial oxygen demand.…”

Section: Discussionmentioning

confidence: 99%

“…All three components combined are called triple-H therapy, a concept that dates back to the 1970s and is based on the Hagen-Poiseuille Law (see formula below). 41 Blood flow is dependent on the difference in pressure over the vessel (ΔP), the radius of the vessel (r), viscosity of blood (η) and the length of the blood vessel (λ). When the vessel is narrowed (in cerebral vasospasm "r" decreases and becomes relatively fixed), the only variables that can be manipulated to improve blood flow are viscosity and pressure.…”

Section: The Potential Role Of Blood Pressure In Improving Cerebral Perfusionmentioning

confidence: 99%

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Patient outcome after cerebrovascular interventions

Akkermans¹

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Part I Perioperative respiratory management in the non-cardiac surgery population Chapter 2 An observational study of end-tidal carbon dioxide trends in general anesthesia Chapter 3 End-tidal carbon dioxide in general anesthesia and its association with postoperative pulmonary complications. A report from the Multicenter Perioperative Outcomes Group Part II Perioperative respiratory and hemodynamic management in patients presenting for cerebrovascular interventions Chapter 4 Blood pressure and end-tidal carbon dioxide ranges during aneurysm occlusion and neurologic outcome after an aneurysmal subarachnoid hemorrhage Chapter 5 The effect of dobutamine and phenylephrine on cerebral perfusion in patients undergoing cerebral bypass surgery: a randomized crossover trial Part III Perioperative cardiovascular risk identification Chapter 6Cardiac events within one year after a subarachnoid hemorrhage: The predictive value of troponin elevation after aneurysm occlusion Chapter 7Postoperative visits by dedicated anesthesiologists in patients with elevated troponin: a retrospective cohort study evaluating postoperative care utility and early detection of complications

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Impact of Cardio-Pulmonary and Intraoperative Factors on Occurrence of Cerebral Infarction After Early Surgical Repair of the Ruptured Cerebral Aneurysms

Cited by 10 publications

References 19 publications

Appropriate Blood Pressure in Cerebral Aneurysm Clipping for Prevention of Delayed Ischemic Neurologic Deficits

Appropriate Blood Pressure in Cerebral Aneurysm Clipping for Prevention of Delayed Ischemic Neurologic Deficits

Acute postoperative neurological deterioration associated with surgery for ruptured intracranial aneurysm: incidence, predictors, and outcomes

Patient outcome after cerebrovascular interventions

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