Influence of blood pressure on internal carotid artery blood flow during combined propofol-remifentanil and thoracic epidural anesthesia
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Influence of blood pressure on internal carotid artery blood flow during combined propofol-remifentanil and thoracic epidural anesthesia. / Olesen, Niels D.; Egesborg, Astrid H.; Frederiksen, Hans-Jorgen; Kitchen, Carl-Christian; Svendsen, Lars B.; Olsen, Niels; Secher, Niels H.
I: Journal of Anaesthesiology Clinical Pharmacology, Bind 38, Nr. 4, 2022, s. 580-587.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Influence of blood pressure on internal carotid artery blood flow during combined propofol-remifentanil and thoracic epidural anesthesia
AU - Olesen, Niels D.
AU - Egesborg, Astrid H.
AU - Frederiksen, Hans-Jorgen
AU - Kitchen, Carl-Christian
AU - Svendsen, Lars B.
AU - Olsen, Niels
AU - Secher, Niels H.
PY - 2022
Y1 - 2022
N2 - Background and Aims: Anesthesia often reduces mean arterial pressure (MAP) to a level that may compromise cerebral blood flow. We evaluated whether phenylephrine treatment of anesthesia-induced hypotension affects internal carotid artery (ICA) blood flow and whether anesthesia affects ICA flow and CO2 reactivity.Material and Methods: The study included twenty-seven patients (65 +/- 11 years; mean +/- SD) undergoing esophageal resection (n = 14), stomach resection (n = 12), or a gastroentero anastomosis (n = 1) during combined propofol-remifentanil and thoracic epidural anesthesia. Duplex ultrasound evaluated ICA blood flow. Evaluations were before and after induction of anesthesia, before and after the administration of phenylephrine as part of standard care to treat anesthesia-induced hypotension at a MAP below 60 mmHg, and the hypocapnic reactivity of ICA flow was determined before and during anesthesia.Results: Induction of anesthesia reduced MAP from 108 +/- 12 to 66 +/- 16 mmHg (P < 0.0001) and ICA flow from 340 +/- 92 to 196 +/- 52 mL/min (P < 0.0001). Phenylephrine was administered to 24 patients (0.1-0.2 mg) and elevated MAP from 53 +/- 8 to 73 +/- 8 mmHg (P = 0.0001) and ICA flow from 191 +/- 43 to 218 +/- 50 mL/min (P = 0.0276). Furthermore, anesthesia reduced the hypocapnic reactivity of ICA flow from 23 (18-33) to 14%/kPa (10-22; P = 0.0068).Conclusion: Combined propofol-remifentanil and thoracic epidural anesthesia affect ICA flow and CO2 reactivity. Phenylephrine partly restored ICA flow indicating that anesthesia-induced hypotension contributes to the reduction in ICA flow.
AB - Background and Aims: Anesthesia often reduces mean arterial pressure (MAP) to a level that may compromise cerebral blood flow. We evaluated whether phenylephrine treatment of anesthesia-induced hypotension affects internal carotid artery (ICA) blood flow and whether anesthesia affects ICA flow and CO2 reactivity.Material and Methods: The study included twenty-seven patients (65 +/- 11 years; mean +/- SD) undergoing esophageal resection (n = 14), stomach resection (n = 12), or a gastroentero anastomosis (n = 1) during combined propofol-remifentanil and thoracic epidural anesthesia. Duplex ultrasound evaluated ICA blood flow. Evaluations were before and after induction of anesthesia, before and after the administration of phenylephrine as part of standard care to treat anesthesia-induced hypotension at a MAP below 60 mmHg, and the hypocapnic reactivity of ICA flow was determined before and during anesthesia.Results: Induction of anesthesia reduced MAP from 108 +/- 12 to 66 +/- 16 mmHg (P < 0.0001) and ICA flow from 340 +/- 92 to 196 +/- 52 mL/min (P < 0.0001). Phenylephrine was administered to 24 patients (0.1-0.2 mg) and elevated MAP from 53 +/- 8 to 73 +/- 8 mmHg (P = 0.0001) and ICA flow from 191 +/- 43 to 218 +/- 50 mL/min (P = 0.0276). Furthermore, anesthesia reduced the hypocapnic reactivity of ICA flow from 23 (18-33) to 14%/kPa (10-22; P = 0.0068).Conclusion: Combined propofol-remifentanil and thoracic epidural anesthesia affect ICA flow and CO2 reactivity. Phenylephrine partly restored ICA flow indicating that anesthesia-induced hypotension contributes to the reduction in ICA flow.
KW - Anesthesia
KW - carotid artery
KW - cerebrovascular circulation
KW - hypotension
KW - POSTOPERATIVE COGNITIVE DYSFUNCTION
KW - OXYGEN-SATURATION
KW - CARBON-DIOXIDE
KW - HYPERTENSIVE PATIENTS
KW - NONCARDIAC SURGERY
KW - NITROUS-OXIDE
KW - VELOCITY
KW - AUTOREGULATION
KW - REACTIVITY
KW - CONSUMPTION
U2 - 10.4103/joacp.JOACP_575_20
DO - 10.4103/joacp.JOACP_575_20
M3 - Journal article
C2 - 36778814
VL - 38
SP - 580
EP - 587
JO - Journal of Anaesthesiology Clinical Pharmacology
JF - Journal of Anaesthesiology Clinical Pharmacology
SN - 0970-9185
IS - 4
ER -
ID: 338352662