The Impact of Systemic Vasoconstrictors on the Cerebral Circulation of Anesthetized Patients

Strebel, S.; Kindler, Christoph; Bissonnette, Bruno; Tschaler, Gabriela; Deanovic, D.

doi:10.1097/00000542-199807000-00012

Cited by 82 publications

(41 citation statements)

References 19 publications

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“…Therefore, the increases in CFV during stellate ganglion stimulation were likely the result of increased mean BP augmenting CFV through vessels with impaired autoregulation. Direct intravenous infusions of norepinephrine into both anaesthetized (38) and conscious (24) human patients also do not affect CBF or CVR. Thus it is not clear that inhibition or stimulation of the stellate ganglion affects CBF in humans.…”

Section: Discussionmentioning

confidence: 98%

Effect of acute exposure to hypergravity (G_X vs. G_Z) on dynamic cerebral autoregulation

Serrador

Wood

Picot

et al. 2001

Journal of Applied Physiology

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We examined the effects of 30 min of exposure to either + 3G x or +3G z centrifugation on cerebrovascular responses to 80 0 head-up tilt (HUT) in 14 healthy individuals. Both before and after +3G x or +3G z centrifugation, eye-level blood pressure (BP ey e ) , end tidal CO 2 (P ET C0 2 ), mean cerebral flow velocity (CFV) in the middle cerebral artery (trans cranial Doppler ultrasound), cerebral vascular resistance (CVR) and dynamic cerebral autoregulatory gain (GAIN) were measured with subjects in the supine position and during subsequent 80 0 HUT for 30 min. Mean BP eye decreased with HUT in both the G x (n= 7) and G z (n=7) groups (P

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Section: Discussionmentioning

confidence: 98%

Effect of acute exposure to hypergravity (G_X vs. G_Z) on dynamic cerebral autoregulation

Serrador

Wood

Picot

et al. 2001

Journal of Applied Physiology

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“…Clinical and experimental studies indicate that the infusion of low concentrations of noradrenaline (<6 µg·min -1 ) do not affect CBF as long as the bloodbrain-barrier is intact. 26,27 Despite infusion of noradrenaline, MAP was lower in patients receiving 2.0 MAC sevoflurane (group II). However, MAP was still within the autoregulatory range during measurements and differences in ARI between patients anesthetized with S(+)-ketamine/propofol or sevoflurane cannot be explained by differences in MAP.…”

Section: Discussionmentioning

confidence: 98%

S(+)-ketamine/propofol maintain dynamic cerebrovascular autoregulation in humans

Engelhard

Werner

Möllenberg

et al. 2001

Can J Anesth/J Can Anesth

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“…The purpose of the present study was to reproduce this crucial clinical situation in pediatric emergency care. NE is a potent vasoactive agent with alphaand beta-adrenergic properties that is widely used for the treatment of hypotension secondary to vasodilatation in hemorrhagic or septic shock (16), and that has no effect on cerebrovascular hemodynamics during intact circulation (17). The rationale for NE therapy during hemorrhagic shock is rooted in the fact that NE has been claimed to shift venous blood from unstressed to stressed vascular bed (18).…”

mentioning

confidence: 99%

Impact of Norepinephrine and Fluid on Cerebral Oxygenation in Experimental Hemorrhagic Shock

et al. 2007

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Few data exist regarding resuscitation of hypovolemic shock in infants, and alternative strategies such as vasopressor therapy merit further evaluation. However, the effects of norepinephrine on cerebral perfusion and oxygenation during hemorrhagic shock in the pediatric population are still unclear. Eight anesthetized piglets were subjected to hypotension by blood withdrawal of 25 mL/kg. Norepinephrine was titrated to achieve baseline mean arterial blood pressure (MAP), and cerebral oxygenation was determined by brain tissue PO 2 (P ti O 2 ) and near-infrared spectroscopy-derived tissue oxygen index (TOI). Then, norepinephrine was stopped, MAP was allowed to decrease again below 30 mm Hg, and shed blood was retransfused. During hemorrhage, TOI dropped from 69 Ϯ 3 to 59 Ϯ 3%, and P ti O 2 from 29 Ϯ 6 to 13 Ϯ 1 mm Hg (mean Ϯ SEM; p Ͻ 0.001). Following norepinephrine, cerebral perfusion pressure (CPP) could be restored immediately, whereas TOI and P ti O 2 did not increase significantly. In contrast, following retransfusion, TOI and P ti O 2 increased to 68 Ϯ 3% and 27 Ϯ 7 mm Hg reaching baseline values, respectively. In conclusion, while norepinephrine increased CPP immediately, cerebral oxygenation as reflected by TOI and P ti O 2 could not be improved by norepinephrine, but only by retransfusion. H ypovolemia is the most common cause of circulatory failure in children (1). When inadequate tissue perfusion is not recognized and treated rapidly, critical tissue hypoxia may develop, leading to multiorgan failure and global cerebral ischemia followed by impaired brain function (2). With respect to hypovolemic and hemorrhagic shock, few clinical and experimental data exist in infants (3). In adults, there is growing evidence that conventionally aggressive fluid resuscitation does not increase the chance of survival in hemorrhagic shock (4). Accordingly, alternative strategies such as vasopressor therapy merit further evaluation. Administration of the widely used norepinephrine (NE) has been advocated to control hypotension, even in the acute phase of hemorrhage (5). Preliminary experimental data have suggested that early administration of NE may improve cerebral perfusion and oxygenation, at least in a model of brain-injury (6). However, the effects of NE on systemic hemodynamics and cerebral perfusion and oxygenation in a pediatric model of hemorrhagic shock are still unclear.NIRS is a relatively new technique with the capacity to detect changes in cerebral hemodynamics and oxygenation continuously and noninvasively at the bedside (7). In addition, impaired cerebral oxygenation has been found to correlate closely to experimental hypotension-induced alterations in cerebral blood flow (CBF) (8). Thus, we undertook this study to determine in a pediatric model of hemorrhagic shock 1) whether changes in cerebral perfusion and oxygenation accompanying hemorrhage could be detected by NIRS, and 2) whether the use of NE would improve cerebral perfusion and oxygenation. MATERIALS AND METHODSThis is an experimental ...

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The Impact of Systemic Vasoconstrictors on the Cerebral Circulation of Anesthetized Patients

Cited by 82 publications

References 19 publications

Effect of acute exposure to hypergravity (G_X vs. G_Z) on dynamic cerebral autoregulation

Effect of acute exposure to hypergravity (G_X vs. G_Z) on dynamic cerebral autoregulation

S(+)-ketamine/propofol maintain dynamic cerebrovascular autoregulation in humans

Impact of Norepinephrine and Fluid on Cerebral Oxygenation in Experimental Hemorrhagic Shock

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The Impact of Systemic Vasoconstrictors on the Cerebral Circulation of Anesthetized Patients

Cited by 82 publications

References 19 publications

Effect of acute exposure to hypergravity (GX vs. GZ) on dynamic cerebral autoregulation

Effect of acute exposure to hypergravity (GX vs. GZ) on dynamic cerebral autoregulation

S(+)-ketamine/propofol maintain dynamic cerebrovascular autoregulation in humans

Impact of Norepinephrine and Fluid on Cerebral Oxygenation in Experimental Hemorrhagic Shock

Contact Info

Product

Resources

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Effect of acute exposure to hypergravity (G_X vs. G_Z) on dynamic cerebral autoregulation

Effect of acute exposure to hypergravity (G_X vs. G_Z) on dynamic cerebral autoregulation