Internal Carotid Artery Blood Flow Response to Anesthesia, Pneumoperitoneum, and Head-up Tilt during Laparoscopic Cholecystectomy
| Autor: | Maria Skytioti, Signe Søvik, Maja Elstad |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Cardiac output medicine.medical_treatment Posture Cardiac index Anesthesia General 030204 cardiovascular system & hematology Young Adult 03 medical and health sciences 0302 clinical medicine Pneumoperitoneum medicine.artery medicine Humans Laparoscopy Aged medicine.diagnostic_test business.industry Hemodynamics Ultrasonography Doppler Blood flow Middle Aged medicine.disease Anesthesiology and Pain Medicine Cholecystectomy Laparoscopic Cerebral blood flow Cerebrovascular Circulation Anesthesia Female Cholecystectomy Internal carotid artery business Blood Flow Velocity Carotid Artery Internal 030217 neurology & neurosurgery |
| Zdroj: | Anesthesiology. 131:512-520 |
| ISSN: | 0003-3022 |
| DOI: | 10.1097/aln.0000000000002838 |
| Popis: | Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Little is known about how implementation of pneumoperitoneum and head-up tilt position contributes to general anesthesia-induced decrease in cerebral blood flow in humans. We investigated this question in patients undergoing laparoscopic cholecystectomy, hypothesizing that cardiorespiratory changes during this procedure would reduce cerebral perfusion. Methods In a nonrandomized, observational study of 16 patients (American Society of Anesthesiologists physical status I or II) undergoing laparoscopic cholecystectomy, internal carotid artery blood velocity was measured by Doppler ultrasound at four time points: awake, after anesthesia induction, after induction of pneumoperitoneum, and after head-up tilt. Vessel diameter was obtained each time, and internal carotid artery blood flow, the main outcome variable, was calculated. The authors recorded pulse contour estimated mean arterial blood pressure (MAP), heart rate (HR), stroke volume (SV) index, cardiac index, end-tidal carbon dioxide (ETco2), bispectral index, and ventilator settings. Results are medians (95% CI). Results Internal carotid artery blood flow decreased upon anesthesia induction from 350 ml/min (273 to 410) to 213 ml/min (175 to 249; −37%, P < 0.001), and tended to decrease further with pneumoperitoneum (178 ml/min [127 to 208], −15%, P = 0.026). Tilt induced no further change (171 ml/min [134 to 205]). ETco2 and bispectral index were unchanged after induction. MAP decreased with anesthesia, from 102 (91 to 108) to 72 (65 to 76) mmHg, and then remained unchanged (Pneumoperitoneum: 70 [63 to 75]; Tilt: 74 [66 to 78]). Cardiac index decreased with anesthesia and with pneumoperitoneum (overall from 3.2 [2.7 to 3.5] to 2.3 [1.9 to 2.5] l · min−1 · m−2); tilt induced no further change (2.1 [1.8 to 2.3]). Multiple regression analysis attributed the fall in internal carotid artery blood flow to reduced cardiac index (both HR and SV index contributing) and MAP (P < 0.001). Vessel diameter also declined (P < 0.01). Conclusions During laparoscopic cholecystectomy, internal carotid artery blood flow declined with anesthesia and with pneumoperitoneum, in close association with reductions in cardiac index and MAP. Head-up tilt caused no further reduction. Cardiac output independently affects human cerebral blood flow. |
| Databáze: | OpenAIRE |
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