A comparison of ultrafast and conventional spectral Doppler ultrasound to measure cerebral blood flow velocity during inguinal hernia repair in infants.

Autor: Rondagh M; Department of Anesthesiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands., Kortenbout AJ; Department of Biomedical Engineering, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands., de Munck S; Department of Surgery, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands., van den Bosch GE; Department of Neonatology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands., Dudink J; Department of Neonatology, UMC Utrecht University Medical Centre Utrecht, Utrecht, the Netherlands., Vos HJ; Department of Biomedical Engineering, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands., Bosch JG; Department of Biomedical Engineering, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands., de Graaff JC; Department of Anesthesiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Anesthesiology, Adrz - Erasmus MC, Goes, the Netherlands; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, United States of America. Electronic address: j.degraaff@erasmusmc.nl.
Jazyk: angličtina
Zdroj: Journal of clinical anesthesia [J Clin Anesth] 2024 Feb; Vol. 92, pp. 111312. Date of Electronic Publication: 2023 Nov 04.
DOI: 10.1016/j.jclinane.2023.111312
Abstrakt: Background: Ultrafast cerebral Doppler ultrasound enables simultaneous quantification and visualization of cerebral blood flow velocity. The aim of this study is to compare the use of conventional and ultrafast spectral Doppler during anesthesia and their potential to show the effect of anesthesiologic procedures on cerebral blood flow velocities, in relation to blood pressure and cerebral oxygenation in infants undergoing inguinal hernia repair.
Methods: A single-center prospective observational cohort study in infants up to six months of age. We evaluated conventional and ultrafast spectral Doppler cerebral ultrasound measurements in terms of number of successful measurements during the induction of anesthesia, after sevoflurane induction, administration of caudal analgesia, a fluid bolus and emergence of anesthesia. Cerebral blood flow velocity was quantified in pial arteries using conventional spectral Doppler and in the cerebral cortex using ultrafast Doppler by peak systolic velocity, end diastolic velocity and resistivity index.
Results: Twenty infants were included with useable conventional spectral Doppler images in 72/100 measurements and ultrafast Doppler images in 51/100 measurements. Intraoperatively, the success rates were 53/60 (88.3%) and 41/60 (68.3%), respectively. Cerebral blood flow velocity increased after emergence for both conventional (end diastolic velocity, from 2.01 to 2.75 cm/s, p < 0.001) and ultrafast spectral Doppler (end diastolic velocity, from 0.59 to 0.94 cm/s), whereas cerebral oxygenation showed a reverse pattern with a decrease after the emergence of the infant (85% to 68%, p < 0.001).
Conclusion: It is possible to quantify cortical blood flow velocity during general anesthesia using conventional and ultrafast spectral Doppler cerebral ultrasound. Cerebral blood flow velocity and blood pressure decreased, while regional cerebral oxygenation increased during general anesthesia. Ultrafast spectral Doppler ultrasound offers novel insights into perfusion within the cerebral cortex, unattainable through conventional spectral ultrasound. Yet, ultrafast Doppler is curtailed by a lower success rate and a more rigorous learning curve compared to conventional method.
Competing Interests: Declaration of Competing Interest The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
(Copyright © 2023. Published by Elsevier Inc.)
Databáze: MEDLINE
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