Effects of Profound Hypotension on Cerebral Blood Flow during Surgery for Intracranial Aneurysms

Farrar, J. K.; Gamache, Francis W.; Ferguson, G. G.; Barker, J.; Varkey, G. P.; Drake, Charles G.

doi:10.1097/00132586-198210000-00020

Cited by 6 publications

(6 citation statements)

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“…CBF was decreased during induced hypotension in patients with impaired autoregulation. 352 In an earlier retrospective study (nϭ112), increased risk of early and delayed neurological deficits was associated with a systolic arterial blood pressure Ͻ60 mm Hg with longer periods of hypotension. 353 Existing data suggest that there could be potential harm from induced hypotension without any evidence regarding benefit.…”

Section: Anesthetic Management During Surgical and Endovascular Treatmentioning

confidence: 97%

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Bederson¹,

Connolly²,

Batjer³

et al. 2009

Stroke

1,163

488

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Section: Anesthetic Management During Surgical and Endovascular Treatmentioning

confidence: 97%

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Bederson¹,

Connolly²,

Batjer³

et al. 2009

Stroke

1,163

488

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“…All of our normal subjects had intact THRs and presumably normal autoregulation. Impaired autoregulation, especially at higher grades, occurs commonly in SAH 9, 10,30,33,41,45,51, and the only patients in our SAH group with intact THRs were of grades I and II. Furthermore, the THR reappeared or vanished as the neurological examination improved or deteriorated in 4 of these patients.…”

Section: Discussionmentioning

confidence: 67%

A bedside test for cerebral autoregulation using transcranial Doppler ultrasound

Giller

1991

Acta neurochir

180

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Although disorders of cerebral autoregulation are commonly seen in neurosurgical disease, there is currently no test of autoregulation in widespread use that may be performed safely at the bedside. The presence of autoregulation, however, can be seen in the brief hyperemic response in the middle cerebral artery distribution following a transient manual carotid artery compression in the neck. This transient hyperemic response (THR) is readily measured with transcranial Doppler techniques, and therefore might serve as a qualitative marker of cerebral autoregulation. To evaluate the THR as a clinical tool, carotid compressions were performed during 172 TCD studies on 79 patients with neurosurgical disorders and on 10 patients without cerebral disease. The results were correlated with clinical status (e.g., Hunt-Hess Grade for subarachnoid hemorrhage and Glasgow Coma Score for trauma). There were no complications arising from the compressions. A separate assessment of autoregulation was made from TCD recordings obtained intraoperatively during 16 procedures and correlated to the pre-operative THRs. Autoregulation was further assessed in 4 patients during a hypotensive challenge, and again compared to the THRs. A strong correlation was seen between the THR results and clinical status. The THR was also strongly correlated with the intraoperative assessments, and all 4 patients receiving hypotensive challenges had abnormal THRs and demonstrated evidence of poor autoregulation during the challenge. None of the control patients had abnormal THRs. The THR arising from transient artery compression is readily detected with TCD techniques and correlates well with clinical status and other indicators of autoregulatory ability.(ABSTRACT TRUNCATED AT 250 WORDS)

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“…Cerebral blood flow was decreased during induced hypotension in patients with impaired autoregulation, but there was no increase in postoperative neurological deficits. 124 In a larger retrospective study (n = 112), increased risk of early and delayed neurological deficits was associated with a systolic arterial blood pressure of less than 60 mm Hg and with longer periods of hypotension. 123 In summary, existing data suggest potential harm from induced hypotension without any evidence regarding benefit.…”

Section: Anesthetic Management During Aneurysm Surgerymentioning

confidence: 94%