Postural Ischæmia and Blood-Pressure

Enderby, G. E. H.

doi:10.1016/s0140-6736(54)91258-1

Cited by 46 publications

(20 citation statements)

References 5 publications

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“…In 1954 Hale Enderby described the technique of postural ischemia, where surgical bleeding was reduced by placing the patient into a steep reverse Trendelenburg tilt [10]. This head-up tilt, in association with volatile anesthesia and ganglionic blocking drugs, caused significant hypotension with systolic arterial pressure often decreasing to below 70 (and in some cases below 50) mmHg [11].…”

Section: Introductionmentioning

confidence: 99%

Effects of Positioning on Cerebral Oxygenation

Soeding

2013

Curr Anesthesiol Rep

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Postural change during anesthesia has a complex effect on the systemic and cerebral circulations which can potentially decrease cerebral blood flow and oxygenation. Cerebral oximetry is emerging as a monitor of cerebral perfusion with widespread application in many types of surgery. The technology is based on the differential absorption of oxygenated and deoxygenated hemoglobin to near-infrared light. However, the dynamic coupling that exists between cerebral arterial, venous and cerebrospinal fluid volumes may influence oximetric readings during postural change. Interpretation of cerebral oxygen saturation measurement must account for these changes in cerebral physiology if monitoring is to predict neurological outcome.

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Section: Introductionmentioning

confidence: 99%

Effects of Positioning on Cerebral Oxygenation

Soeding

2013

Curr Anesthesiol Rep

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“…Little (1956) has stated that 'certain postures threaten ischaemia to vital organs, particularly the brain, because induced hypotension and gravity may combine to lower the local blood pressure (as quite distinct from the blood pressure at heart level) below that necessary to fulfil the requirements of cerebral metabolism'. Enderby (1954) calculated that with a 30°head-up tilt and a cardiac systolic blood pressure of 60 mm. Hg the cerebral blood pressure would be only 30 mm.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Complications of Hypotensive Anaesthesia in a Healthy Adult

Brierley¹,

Cooper²

1963

Survey of Anesthesiology

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The employment of deliberately induced hypotension with the purpose of reducing haemorrhage or oedema is a procedure that does not yet receive the unequivocal endorsement of all anaesthetists and surgeons. The There was no change until the sixth post-operative day when occasional flexor spasms of the spine were noted and there was more response to stimulation.By the twelfth day, there appeared to be some fixation of the eyes on nearby objects, and, although tone was increased in the arms, the tendon reflexes were reported as normal. On the twenty-first post-operative day, the patient seemed to comprehend simple instructions and began to take food slowly by mouth.Neurological examination at three and a half weeks showed normal fundi and equal and reactive pupils. All four limbs were spastic but some voluntary movement was present and was stronger on the right. Pin-prick was felt on both sides of the body and both plantar responses were extensor. Slow improvement continued and, five weeks after the operation, the patient began to say 'yes' and 'no' in reply to simple questions and to regain bowel and bladder control.At six weeks, walking was possible with assistance but as speech returned it was apparent that there was disorientation and a gross memory deficit for both past and present events. Emotional lability developed with violent temper tantrums at minor frustrations.Slow improvement was maintained, and four months after the operation, the patient knew her name and that she was in hospital, but not the date, her address, or the name of the hospital. She could converse about very simple matters but confabulated freely when asked how she spent the time. Her speech was slurred but there was no dysphasia. All limbs were hypertonic with exaggerated reflexes. She walked in a flexed manner without swinging her arms. The left side was slightly weaker than the right and no sensory loss was found. The plantar reflexes were equivocal.

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“…37,38 The recommendation derived from outcome parameters of the time suggested that a systolic blood pressure of 60 mmHg measured at the heart level would allow adequate cerebral perfusion. 39 The debate was reactivated recently by the publication of a report of four middle-aged patients who suffered diverse catastrophic cerebral injuries from having shoulder surgery in the beach chair (upright) position. The authors speculated that neck rotation, embolism, and hypotension may have been causative.…”

Section: Congenital Variation Of the Circle Of Willismentioning

confidence: 99%