Impact of hypotension on cerebral perfusion during general anesthesia induction: A prospective observational study in adults.

Autor: Chaix, Isabelle, Manquat, Elsa, Liu, Ngai, Casadio, Maria Chiara, Ludes, Pierre‐Olivier, Tantot, Audrey, Lopes, Jean‐Paul, Touchard, Cyril, Mateo, Joaquim, Mebazaa, Alexandre, Gayat, Etienne, Vallée, Fabrice, Ludes, Pierre-Olivier, Lopes, Jean-Paul
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Zdroj: Acta Anaesthesiologica Scandinavica; May2020, Vol. 64 Issue 5, p592-601, 10p, 4 Charts, 5 Graphs
Abstrakt: Introduction: During anesthesia, decreases in mean arterial pressure (MAP) are common but the impact on possible cerebral hypoperfusion remains a matter of debate. We evaluated cerebral perfusion in patients with or without cardiovascular comorbidities (Hi-risk vs Lo-risk) during induction of general anesthesia and during hypotensive episodes.Methods: Patients scheduled for neuroradiology procedure using standardized target-controlled Propofol-Remifentanil infusion were prospectively included. Monitoring included Transcranial Doppler (TCD) measuring mean blood velocity of the middle cerebral artery (Vm), Bispectral Index with burst suppression ratio (SR) and cerebral Near-Infrared Spectroscopy (NIRS). Hypotensive episodes were treated with a 10 µg bolus of Norepinephrine.Results: Eighty-one patients were included, 37 Hi-risk and 44 Lo-risk. During induction of anesthesia, MAP and Vm decreased in all patients, with greater changes observed in Hi-risk patients compared to Lo-risk patients (-34 [38-29]% vs -17 [25-8]%, P < .001 and -39 [45-29]% vs -28 [34-19]%, P < .01 respectively). In Hi-risk patients, the MAP-decrease correlated with the Vm-decrease (r = .48, P < .01), and was associated with more frequent occurrences of SR (21 vs 5 patients, P < .01 for Hi-risk vs Lo-risk). For the MAP-increase induced by norepinephrine, the Vm-increase was greater in Hi-risk than in Lo-risk patients (+15 [8-21]% vs +4 [1-11]%, P < .01). During induction and norepinephrine boluses, NIRS values did not follow acute changes of Vm.Conclusion: Our results showed that Hi-risk patients had a higher decrease in MAP and Vm, and a higher occurrence of SR during induction of anesthesia than Lo-risk patients. Correction of MAP with norepinephrine increased Vm mainly in Hi-rik patients. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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