Cerebral Autoregulation and CO2 Reactivity Before and After Elective Supratentorial Tumor Resection

Sharma, Deepak; Bithal, Parmod K.; Dash, Hari H.; Chouhan, Rajendra Singh; Sookplung, Pimwan; Vavilala, Monica S.

doi:10.1097/ana.0b013e3181c9fbf1

Cited by 34 publications

(18 citation statements)

References 27 publications

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“…The first determined the transient hyperemic response ratio (THRR), a technique often used clinically (24–27), thereby making these studies conducted in a basic science animal model of TBI more translatable. The transient hyperemic response ratio (THRR) is calculated by observing the change in mean Laser Doppler Flow after the release of 10 second compression of the common carotid artery, as described previously (24–27). THRR is calculated using the formula: THRR = F3/F1 where F1 and F3 are the flow immediately before compression and after the release of compression, respectively.…”

Section: Methodsmentioning

confidence: 99%

Preferential Protection of Cerebral Autoregulation and Reduction of Hippocampal Necrosis With Norepinephrine After Traumatic Brain Injury in Female Piglets*

Armstead

Riley

Vavilala

2016

Pediatric Critical Care Medicine

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Objective Traumatic brain injury (TBI) contributes to morbidity in children and boys are disproportionately represented. Cerebral autoregulation is impaired after TBI, contributing to poor outcome. Cerebral Perfusion Pressure (CPP) is often normalized by use of vasopressors to increase MAP. In prior studies, we observed that phenylephrine prevented in female but exacerbated impairment of autoregulation in male piglets after fluid percussion injury (FPI). In contrast, dopamine prevented impairment of autoregulation in both sexes after FPI, suggesting that pressor choice impacts outcome. The ERK isoform of mitogen activated protein kinase (MAPK) produces hemodynamic impairment after FPI, but the role of the cytokine IL-6 is unknown. We investigated whether norepinephrine (NE) sex dependently protects autoregulation and limits histopathology after FPI and the role of ERK and IL-6 in that outcome. Design Prospective, randomized animal study. Setting University laboratory. Subjects Newborn (1–5 day old) pigs. Interventions CPP, CBF, and pial artery diameter were determined before and after FPI in piglets equipped with a closed cranial window and post treated with NE. CSF ERK MAPK was determined by ELISA. Measurements and Main Results NE does not protect autoregulation or prevent reduction in CBF in male but fully protects autoregulation in female piglets after FPI. Papaverine induced dilation was unchanged by FPI and NE. NE increased ERK MAPK upregulation in male but blocked such upregulation in female piglets after FPI. NE aggravated IL-6 upregulation in males in an ERK MAPK dependent mechanism but blocked IL-6 upregulation in females after FPI. NE augments loss of neurons in CA1 and CA3 hippocampus of male piglets after FPI in an ERK MAPK and IL-6 dependent manner, but prevents loss of neurons in females after FPI. Conclusions NE protects autoregulation and limits hippocampal neuronal cell necrosis via modulation of ERK MAPK and IL-6 after FPI in a sex dependent manner.

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Section: Methodsmentioning

confidence: 99%

Preferential Protection of Cerebral Autoregulation and Reduction of Hippocampal Necrosis With Norepinephrine After Traumatic Brain Injury in Female Piglets*

Armstead

Riley

Vavilala

2016

Pediatric Critical Care Medicine

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“…17,18 Cerebral autoregulation was tested via two techniques. The first method determined the transient hyperemic response ratio (THRR), a technique often used clinically, [20][21][22][23] thereby making these studies conducted in a basic science animal model of TBI more translatable. The THRR is calculated by observing the change in mean laser Doppler flow after the release of 10-sec compression of the common carotid artery, as described previously.…”

Section: Protocolmentioning

confidence: 99%

“…The THRR is calculated by observing the change in mean laser Doppler flow after the release of 10-sec compression of the common carotid artery, as described previously. [20][21][22][23] THRR was calculated using the formula: THRR = F3/F1 where F1 and F3 are the flow immediately before compression and after the release of compression, respectively. Compression ratio (CR) was defined as the magnitude of decrease in flow during carotid compression and was calculated as: CR (%) = (F1-F2) · 100/F1 where F2 is the flow immediately after compression.…”

Section: Protocolmentioning

confidence: 99%

Retracted:Norepinephrine Protects Cerebral Autoregulation and Reduces Hippocampal Necrosis after Traumatic Brain Injury via Blockade of ERK MAPK and IL-6 in Juvenile Pigs

Armstead

Riley

Vavilala

2016

Journal of Neurotrauma

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Traumatic brain injury (TBI) contributes to morbidity in children, and boys are disproportionately represented. Cerebral autoregulation is impaired after TBI, contributing to poor outcome. Cerebral perfusion pressure (CPP) is often normalized by use of vasoactive agents to increase mean arterial pressure (MAP). In prior studies of 1-to 5-day-old newborn piglets, we observed that norepinephrine (NE) preferentially protected cerebral autoregulation and prevented hippocampal necrosis in females but not males after fluid percussion injury (FPI). The ERK isoform of mitogen activated protein kinase (MAPK) produces hemodynamic impairment after FPI, but less is known about the role of the cytokine interleukin-6 (IL-6). We investigated whether NE protects autoregulation and limits histopathology after FPI in older juvenile (4-week-old) pigs and the role of ERK and IL-6 in that outcome by sex. Results show that NE significantly protects autoregulation and prevents reduction in cerebral blood flow (CBF) in both male and female juvenile pigs after FPI; co-administration of the ERK antagonist U 0126 with NE fully protects both indices of outcome. Papaverine induced dilation was unchanged by FPI and NE. NE blunted ERK MAPK and IL-6 upregulation in both males and females after FPI. NE attenuated loss of neurons in CA1 and CA3 hippocampus of males and females after FPI. These data indicate that NE protects autoregulation and limits hippocampal neuronal cell necrosis via blockade of ERK and IL-6 after FPI in both male and female juvenile pigs. These data suggest that use of NE to improve outcome after TBI is both sex and age dependent.

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“…According to the previous literature, pre-operative cerebral auto-regulation was impaired in a significant number of patients with large supratentorial tumor size and midline shift more than 5 mm and was associated with post-operative impaired cerebral autoregulation during the first 24 hours after the surgery [15]. In this study we tested the applicability of the method on patients with brain tumor after surgical resection.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of non-invasive intracranial pressure measurement

et al. 2012

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AbstractNon-invasive measurement of intracranial pressure (ICP) reduces the complications and cost for both patient and health care systems. Improvement of non-invasive methods has led to development of systems for reproducing continuous, real-time non-invasive ICP signals. So far, non-invasive methods have been tailored for the patients with head trauma. We have used Schmidt’s auto-adaptive method to assess the accuracy of this method for patients after surgery for supratentorial brain tumors. Data from forty patients with the diagnosis of brain tumor operated from 2008 to 2010 were used to estimate the accuracy of Schmidt’s method in our patients. We obtained the model parameters from 30 recordings. We determined the ICP wave form for the remaining patients by both invasive and non-invasive techniques. In the test group, by invasive method, the mean ICP±2SD was 17.1 ± 6.6 mmHg and using non-invasive method, the mean ICP ± 2SD was 16.5 ± 5.4 mmHg. The calculated error was 4.6 mmHg using root mean square errors. The average Pearson correlation between the estimated and real waveforms was 0.92. We believe that application of this method is acceptable for post-operative assessment of ICP in brain tumor patients.

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Cerebral Autoregulation and CO2 Reactivity Before and After Elective Supratentorial Tumor Resection

Abstract: Preoperative cerebral autoregulation was impaired in a significant number of patients with large supratentorial tumor size and midline shift more than 5 mm and was associated with postoperative impaired cerebral autoregulation during the first 24 hours after the surgery.

Cited by 34 publications

References 27 publications

Preferential Protection of Cerebral Autoregulation and Reduction of Hippocampal Necrosis With Norepinephrine After Traumatic Brain Injury in Female Piglets*

Preferential Protection of Cerebral Autoregulation and Reduction of Hippocampal Necrosis With Norepinephrine After Traumatic Brain Injury in Female Piglets*

Retracted:Norepinephrine Protects Cerebral Autoregulation and Reduces Hippocampal Necrosis after Traumatic Brain Injury via Blockade of ERK MAPK and IL-6 in Juvenile Pigs

Accuracy of non-invasive intracranial pressure measurement

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