nach oben

Erschienen in:

14.03.2019 | Original Work

Propofol/Remifentanil Anesthesia Might Not Alter the Middle Cerebral Artery Diameter by Digital Subtraction Angiography

verfasst von: Stefano Arrigoni-Marocco, Nicolas Engrand, Vittorio Civelli, Joaquim Mateo, Marc-Antoine Labeyrie, Jean-Pierre Saint-Maurice, Alexandre Mebazaa, Etienne Gayat, Emmanuel Houdart, Fabrice Vallée

Erschienen in: Neurocritical Care | Ausgabe 2/2019

Einloggen, um Zugang zu erhalten

Abstract

Introduction

Transcranial Doppler (TCD) of the middle cerebral artery (MCA) enables the measurement of the mean blood velocity (MCA_Vm) and the estimation of the cerebral blood flow (CBF), provided that no significant changes occur in the MCA diameter (MCA_Diam). Previous studies described a decrease in the MCA_Vm associated with the induction of total intravenous anesthesia (TIVA) by propofol and remifentanil. This decrease in blood velocity might be interpreted as a decrease in the CBF only where the MCA_Diam is not modified across TCD examinations.

Methods

In this observational study, we measured the MCA_Diam of 24 subjects (almost exclusively females) on digital subtraction angiography under awake and TIVA conditions.

Results

Across the two phases, we observed a decrease in the mean arterial blood pressure (from 84 ± 9 to 71 ± 6 mmHg; p < 0.001) and heart rate (76 ± 10 vs. 65 ± 8 beats/min; p < 0.001), and a concomitant decrease in the MCA_Vm (61 vs. 42 cm/s; p < 0.001). In contrast, the MCA_Diam did not vary in association with TIVA (2.3 ± 0.2 vs. 2.3 ± 0.2 mm; p = 0.52).

Conclusions

Those results suggested that in this population, no significant changes in the MCA_Diam are associated with TIVA.

Smielewski P, Czosnyka M, Kirkpatrick P, McEroy H, Rutkowska H, Pickard JD. Assessment of cerebral autoregulation using carotid artery compression. Stroke. 1996;27(12):2197–203.CrossRef

Ursino M, Lodi CA. A simple mathematical model of the interaction between intracranial pressure and cerebral hemodynamics. J Appl Physiol Bethesda Md 1985. 1997;82(4):1256–69.

Vajkoczy P, Horn P, Thome C, Munch E, Schmiedek P. Regional cerebral blood flow monitoring in the diagnosis of delayed ischemia following aneurysmal subarachnoid hemorrhage. J Neurosurg. 2003;98(6):1227–34.CrossRef

Lanfranchi PA, Somers VK. Arterial baroreflex function and cardiovascular variability: interactions and implications. Am J Physiol Regul Integr Comp Physiol. 2002;283(4):R815–26.CrossRef

Donnelly J, Aries MJ, Czosnyka M. Further understanding of cerebral autoregulation at the bedside: possible implications for future therapy. Expert Rev Neurother. 2015;15(2):169–85.CrossRef

Aaslid R, Markwalder TM, Nornes H. Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg. 1982;57(6):769–74.CrossRef

D’Andrea A, Conte M, Scarafile R, Riegler L, Cocchia R, Pezzullo E, et al. Transcranial Doppler ultrasound: Physical principles and principal applications in neurocritical care unit. J Cardiovasc Echogr. 2016;26(2):28.CrossRef

Compton JS, Redmond S, Symon L. Cerebral blood velocity in subarachnoid haemorrhage: a transcranial Doppler study. J Neurol Neurosurg Psychiatry. 1987;50(11):1499–503.CrossRef

Cigada M, Marzorati S, Tredici S, Iapichino G. Cerebral CO₂ vasoreactivity evaluation by transcranial Doppler ultrasound technique: a standardized methodology. Intensive Care Med. 2000;26(6):729–32.CrossRef

10.

Feri M, Ralli L, Felici M, Vanni D, Capria V. Transcranial Doppler and brain death diagnosis. Crit Care Med. 1994;22(7):1120–6.CrossRef

11.

Giller CA, Purdy P, Giller A, Batjer HH, Kopitnik T. Elevated transcranial Doppler ultrasound velocities following therapeutic arterial dilation. Stroke. 1995;26(1):123–7.CrossRef

12.

Brauer P, Kochs E, Werner C, Bloom M, Policare R, Pentheny S, et al. Correlation of transcranial Doppler sonography mean flow velocity with cerebral blood flow in patients with intracranial pathology. J Neurosurg Anesthesiol. 1998;10(2):80–5.CrossRef

13.

Moppett IK, Mahajan RP. Transcranial Doppler ultrasonography in anaesthesia and intensive care. Br J Anaesth. 2004;93(5):710–24.CrossRef

14.

Giller CA, Bowman G, Dyer H, Mootz L, Krippner W. Cerebral arterial diameters during changes in blood pressure and carbon dioxide during craniotomy. Neurosurgery. 1993;32(5):737–41 (discussion 741–742).CrossRef

15.

Verbree J, Bronzwaer A, van Buchem MA, Daemen M, van Lieshout JJ, van Osch M. Middle cerebral artery diameter changes during rhythmic handgrip exercise in humans. J Cereb Blood Flow Metab Off J Int Soc Cereb Blood Flow Metab. 2017;37(8):2921–7.CrossRef

16.

Conti A. Cerebral haemodynamic changes during propofol-remifentanil or sevoflurane anaesthesia: transcranial Doppler study under bispectral index monitoring. Br J Anaesth. 2006;97(3):333–9.CrossRef

17.

Purrucker JC, Renzland J, Uhlmann L, Bruckner T, Hacke W, Steiner T, et al. Volatile sedation with sevoflurane in intensive care patients with acute stroke or subarachnoid haemorrhage using AnaConDa ^®: an observational study † †Parts of this work have been presented and awarded at the annual meeting of the German Interdisciplinary Association of Intensive Care and Emergency Medicine (DIVI), December 2013, Leipzig, Germany. Br J Anaesth. 2015;114(6):934–43.CrossRef

18.

Vandesteene A, Trempont V, Engelman E, Deloof T, Focroul M, Schoutens A, et al. Effect of propofol on cerebral blood flow and metabolism in man. Anaesthesia. 1988;43(Suppl):42–3.CrossRef

19.

Schregel W, Bredenkötter U, Sihle-Wissel M, Cunitz G. Transkranielle Dopplersonographie: effekte intravenöser Anästhetika bei neurochirurgischen Patienten. Ultraschall Med. 2008;16(02):60–4.CrossRef

20.

Nakamura K, Hatano Y, Hirakata H, Nishiwada M, Toda H, Mori K. Direct vasoconstrictor and vasodilator effects of propofol in isolated dog arteries. Br J Anaesth. 1992;68(2):193–7.CrossRef

21.

Gelb AW, Zhang C, Hamilton JT. Propofol induces dilation and inhibits constriction in guinea pig basilar arteries. Anesth Analg. 1996;83(3):472–6.CrossRef

22.

Turan N, Heider RA, Roy AK, Miller BA, Mullins ME, Barrow DL, et al. Current perspectives in imaging modalities for the assessment of unruptured intracranial aneurysms: a comparative analysis and review. World Neurosurg. 2018;113:280–92.CrossRef

23.

Vallée F, Passouant O, Le Gall A, Joachim J, Mateo J, Mebazaa A, et al. Norepinephrine reduces arterial compliance less than phenylephrine when treating general anesthesia-induced arterial hypotension. Acta Anaesthesiol Scand. 2017;61(6):590–600.CrossRef

24.

Tarasów E, Abdulwahed Saleh Ali A, Lewszuk A, Walecki J. Measurements of the middle cerebral artery in digital subtraction angiography and MR angiography. Med Sci Monit Int Med J Exp Clin Res. 2007;13(Suppl 1):65–72.

25.

Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet Lond Engl. 1986;1(8476):307–10.CrossRef

26.

Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86(2):420–8.CrossRef

27.

Serrador JM, Picot PA, Rutt BK, Shoemaker JK, Bondar RL. MRI measures of middle cerebral artery diameter in conscious humans during simulated orthostasis. Stroke. 2000;31(7):1672–8.CrossRef

28.

Möller Petrun A, Kamenik M. Bispectral index-guided induction of general anaesthesia in patients undergoing major abdominal surgery using propofol or etomidate: a double-blind, randomized, clinical trial. Br J Anaesth. 2013;110(3):388–96.CrossRef

29.

Alkire MT, Haier RJ, Barker SJ, Shah NK, Wu JC, Kao YJ. Cerebral metabolism during propofol anesthesia in humans studied with positron emission tomography. Anesthesiology. 1995;82(2):393–403 (discussion 27A).CrossRef

30.

Johnston AJ, Steiner LA, Chatfield DA, Coleman MR, Coles JP, Al-Rawi PG, et al. Effects of propofol on cerebral oxygenation and metabolism after head injury. Br J Anaesth. 2003;91(6):781–6.CrossRef

31.

Harrison JM, Girling KJ, Mahajan RP. Effects of target-controlled infusion of propofol on the transient hyperaemic response and carbon dioxide reactivity in the middle cerebral artery. Br J Anaesth. 1999;83(6):839–44.CrossRef

32.

Van Hemelrijck J, Fitch W, Mattheussen M, Van Aken H, Plets C, Lauwers T. Effect of propofol on cerebral circulation and autoregulation in the baboon. Anesth Analg. 1990;71(1):49–54.PubMed

33.

Ciobanu L, Reynaud O, Uhrig L, Jarraya B, Le Bihan D. Effects of anesthetic agents on brain blood oxygenation level revealed with ultra-high field MRI. Chang AYW, editor. PLoS ONE. 2012;7(3):e32645.CrossRef

34.

Kadoi Y, Saito S. Effects of adding remifentanil to propofol anesthesia on systemic hemodynamics, cardiac output, and middle cerebral artery flow velocity during electroconvulsive therapy: a pilot study. J ECT. 2015;31(2):98–100.CrossRef

35.

Lagace A, Karsli C, Luginbuehl I, Bissonnette B. The effect of remifentanil on cerebral blood flow velocity in children anesthetized with propofol1. Pediatr Anesth. 2004;14(10):861–5.CrossRef

36.

Paris A, Scholz J, von Knobelsdorff G, Tonner PH, Esch JS. The effect of remifentanil on cerebral blood flow velocity. Anesth Analg. 1998;87(3):569–73.PubMed

37.

Lenck S, Vallée F, Labeyrie M-A, Touitou V, Saint-Maurice J-P, Guillonnet A, et al. Stenting of the lateral sinus in idiopathic intracranial hypertension according to the type of stenosis. Neurosurgery. 2017;80(3):393–400.CrossRef

38.

Schregel W, Schaefermeyer H, Sihle-Wissel M, Klein R. Transcranial Doppler sonography during isoflurane/N₂O anaesthesia and surgery: flow velocity, ‘vessel area’ and ‘volume flow’. Can J Anaesth J Can Anesth. 1994;41(7):607–12.CrossRef

Titel: Propofol/Remifentanil Anesthesia Might Not Alter the Middle Cerebral Artery Diameter by Digital Subtraction Angiography
verfasst von: Stefano Arrigoni-Marocco
Nicolas Engrand
Vittorio Civelli
Joaquim Mateo
Marc-Antoine Labeyrie
Jean-Pierre Saint-Maurice
Alexandre Mebazaa
Etienne Gayat
Emmanuel Houdart
Fabrice Vallée
Publikationsdatum: 14.03.2019
Verlag: Springer US
Erschienen in: Neurocritical Care / Ausgabe 2/2019
Print ISSN: 1541-6933
Elektronische ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-019-00699-3

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Neurologie

Sind Frauen die fähigeren Ärzte?

30.04.2024 Gendermedizin Nachrichten

Patienten, die von Ärztinnen behandelt werden, dürfen offenbar auf bessere Therapieergebnisse hoffen als Patienten von Ärzten. Besonders scheint das auf weibliche Kranke zuzutreffen, wie eine Studie zeigt.

Akuter Schwindel: Wann lohnt sich eine MRT?

28.04.2024 Schwindel Nachrichten

Akuter Schwindel stellt oft eine diagnostische Herausforderung dar. Wie nützlich dabei eine MRT ist, hat eine Studie aus Finnland untersucht. Immerhin einer von sechs Patienten wurde mit akutem ischämischem Schlaganfall diagnostiziert.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Frühe Alzheimertherapie lohnt sich

25.04.2024 AAN-Jahrestagung 2024 Nachrichten

Ist die Tau-Last noch gering, scheint der Vorteil von Lecanemab besonders groß zu sein. Und beginnen Erkrankte verzögert mit der Behandlung, erreichen sie nicht mehr die kognitive Leistung wie bei einem früheren Start. Darauf deuten neue Analysen der Phase-3-Studie Clarity AD.

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Chronische Unterbauch- und Viszeralschmerzen in der Praxis managen"

Springer Medizin

Abstract

Introduction

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 2/2019

A Survey of Multidenominational Rabbis on Death by Neurologic Criteria

Increased Intracranial Pressure Attenuates the Pulsating Component of Cerebral Venous Outflow

Objections to Brain Death Determination: Religion and Neuroscience

Clinical, Electroencephalographic Features and Prognostic Factors of Cefepime-Induced Neurotoxicity: A Retrospective Study

Cerebellar Hippocampal and Basal Nuclei Transient Edema with Restricted diffusion (CHANTER) Syndrome