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The measurement of one arm-brain circulation time is usually considered as the time taken for unconsciousness, after injection of bolus dose of intravenous anesthetic agents. However, arm-brain circulation time varies with many factors such as lipid solubility, pharmacokinetic profile, circulatory volume and cardiac output. Some patients, especially the elderly and those with low cardiac output states, may have a longer arm-brain circulation time and hence during induction, additional boluses of anesthetic agents need to be delayed to avoid adverse hemodynamic consequences. Digital subtraction angiography (DSA) is the gold standard for the measurement of cerebral circulation time;1,2 however, this may not be logistically feasible, and the method of injection of dye differs from that of anesthetic induction.

Can Indocyanine Green Angiography be Used for Measuring One Arm-Brain Circulation Time?