The Upper Limit of Cerebral Blood Flow Autoregulation in Acute Intracranial Hypertension

Hauerberg, John; Ma, Xiaochi; Willumsen, Lisette; Pedersen, Daniella Bach; Juhler, Marianne

doi:10.1097/00008506-199804000-00007

Cited by 19 publications

(6 citation statements)

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“…In severe ICH group there was an important CVR increase after infusion of saline solution that remained adequate after balloon deflation; it is important to notice the relation between CVR and sCA index in both groups (Figures 3 and 4 ). Other studies have described a significant reduction in the CA plateau during severe ICH possibly related to CVR decrease [ 7 , 14 , 17 , 18 ]. In addition, a reduction in CVR may trigger an increase in the permeability of the blood brain barrier and a consequential expansion of the free cortical water content [ 14 ], which may be an additional factor increasing ICP.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Induction and Treatment of Intracranial Hypertension on Cerebral Autoregulation: An Experimental Study

Oliveira

Salinet

Nogueira

et al. 2018

Neurology Research International

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Background This study aimed to analyse cerebral autoregulation (CA) during induction and treatment of intracranial hypertension (ICH) in an experimental model. Materials and Methods Landrace and Duroc piglets were divided into mild and severe ICH groups. Four or seven millilitres of saline solution was infused into paediatric bladder catheter inserted in the parietal lobe (balloon inflation). After 1.5 h, a 3% saline solution was infused via venous catheter, and 30 min later, the bladder catheter balloon was deflated (surgery). The cerebral static autoregulation (sCA) index was evaluated using cerebral blood flow velocities (CBFV) obtained with Doppler ultrasound. Results Balloon inflation increased ICP in both groups. The severe ICH group showed significantly lower sCA index values (p=0.001, ANOVA) after balloon inflation (ICH induction) and a higher sCA index after saline injection (p=0.02) and after surgery (p=0.04). ICP and the sCA index were inversely correlated (r=−0.68 and p<0.05). CPP and the sCA index were directly correlated (r=0.74 and p<0.05). Conclusion ICH was associated with local balloon expansion, which triggered CA impairment, particularly in the severe ICH group. Moreover, ICP-reducing treatments were associated with improved CA in subjects with severe ICH.

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Section: Discussionmentioning

confidence: 99%

The Effects of Induction and Treatment of Intracranial Hypertension on Cerebral Autoregulation: An Experimental Study

Oliveira

Salinet

Nogueira

et al. 2018

Neurology Research International

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“…Also, both the upper and lower thresholds are shifted to the left [22]. In acute intracranial hypertension, upper and lower limits of the autoregulatory plateau were shifted to the left and the autoregulatory plateau narrowed, because the shift of the upper limit was more pronounced than that of the lower limit [23]. Although a recent study [24] reported no change in CBF velocity in response to phenylephrine-induced increases in MAP during anesthesia with 1.5 MAC sevoflurane, a low dose of sevoflurane may cause a small positive slope, whereas propofol may not [25].…”

Section: Discussionmentioning

confidence: 99%

The effects of sevoflurane and propofol anesthesia on cerebral oxygenation in gynecological laparoscopic surgery

Kim

Kwon

Cho

et al. 2011

Korean J Anesthesiol

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BackgroundBoth the Trendelenburg position and pneumoperitoneum with carbon dioxide have been reported to increase intracranial pressure (ICP) and to alter cerebral blood flow or cerebral blood volume. Also anesthetic agents have variable effects on cerebral hemodynamics and ICP. The present study was conducted to determine whether regional cerebral oxygen saturation (rSO2) values differ between propofol and sevoflurane anesthesia during laparoscopic surgery in the Trendelenburg position.MethodsThirty-two adult women undergoing gynecological laparoscopic surgery were divided into sevoflurane and propofol groups. rSO2 values were recorded at 10 min after induction in the neutral position (Tpre), 10 min after the pneumoperitoneum in the Trendelenburg position (Tpt) and 10 min after desufflation in the neutral position (Tpost). For analysis of rSO2, we did ANOVA and univariate two-way ANCOVA with covariates being mean arterial pressure and end tidal carbon dioxide tension.ResultsBetween sevoflurane and propofol groups, the change in rSO2 was significantly different even after ANCOVA. rSO2 at Tpt (76.3 ± 5.9% in sevoflurane vs 69.4 ± 5.8% in propofol) and Tpost (69.5 ± 7.1% in sevoflurane vs 63.8 ± 6.6% in propofol) were significantly higher in the sevoflurane group compared with the propofol group. In the propofol group, rSO2 at Tpost was significantly lower than at Tpre (71.1 ± 4.8%) and cerebral oxygen desaturation occurred in two patients (14.3%).ConclusionsSignificantly lower rSO2 values were observed in the propofol group during gynecological laparoscopic surgery. The possibility of cerebral oxygen desaturation should not be overlooked during propofol anesthesia even after desufflation of the abdomen in the neutral position.

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“…Both of these two mechanisms have much importance in providing adequate CBF [ 69 ]. Secondary brain damage results in the impairment of these regulating mechanisms [ 70 ]. Constant CBF is maintained even at variable CPPs by cerebral autoregulation [ 71 ].…”

Section: Secondary Injurymentioning

confidence: 99%

Pioglitazone Therapy and Fractures: Systematic Review and Meta- Analysis

Pavlova¹,

Filipova²,

Uzunova³

et al. 2018

EMIDDT

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Introduction: Thiazolidinediones are a group of synthetic medications used in type 2 diabetes treatment. Among available thiazolidinediones, pioglitazone is gaining increased attention due to its lower cardiovascular risk in type 2 diabetes mellitus sufferers and seems a promising future therapy. Accumu-lating evidence suggests that diabetic patients may exert bone fractures due to such treatments. Simulta-neously, the female population is thought to be at greater risk. Still, the safety outcomes of pioglitazone treatment especially in terms of fractures are questionable and need to be clarified.Methods: We searched MEDLINE, Scopus, PsyInfo, eLIBRARY.ru electronic databases and clinical trial registries for studies reporting an association between pioglitazone and bone fractures in type 2 dia-betes mellitus patients published before Feb 15, 2016. Among 1536 sources that were initially identified, six studies including 3172 patients proved relevant for further analysis.Result: Pooled analysis of the included studies demonstrated that after treatment with pioglitazone pa-tients with type 2 diabetes mellitus had no significant increase in fracture risk [odds ratio (OR): 1.18, 95% confidence interval (CI): 0.82 to 1.71, p=0.38] compared to other antidiabetic drugs or placebo. Additionally, no association was found between the risk of fractures and pioglitazone therapy duration. The gender of the patients involved was not relevant to the risk of fractures, too.Conclusion: Pioglitazone treatment in diabetic patients does not increase the incidence of bone fractures. Moreover, there is no significant association between patients’ fractures, their gender and the period of exposure to pioglitazone. Additional longitudinal studies need to be undertaken to obtain more detailed information on bone fragility and pioglitazone therapy

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The Upper Limit of Cerebral Blood Flow Autoregulation in Acute Intracranial Hypertension

Cited by 19 publications

References 0 publications

The Effects of Induction and Treatment of Intracranial Hypertension on Cerebral Autoregulation: An Experimental Study

The Effects of Induction and Treatment of Intracranial Hypertension on Cerebral Autoregulation: An Experimental Study

The effects of sevoflurane and propofol anesthesia on cerebral oxygenation in gynecological laparoscopic surgery

Pioglitazone Therapy and Fractures: Systematic Review and Meta- Analysis

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