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Impact of hypotension on cerebral perfusion during general anesthesia induction: A prospective observational study in adults
Author(s) -
Chaix Isabelle,
Manquat Elsa,
Liu Ngai,
Casadio Maria Chiara,
Ludes PierreOlivier,
Tantot Audrey,
Lopes JeanPaul,
Touchard Cyril,
Mateo Joaquim,
Mebazaa Alexandre,
Gayat Etienne,
Vallée Fabrice
Publication year - 2020
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.13537
Subject(s) - medicine , anesthesia , cerebral perfusion pressure , bispectral index , transcranial doppler , burst suppression , remifentanil , propofol , mean arterial pressure , bolus (digestion) , blood pressure , middle cerebral artery , perfusion , prospective cohort study , cerebral blood flow , ischemia , electroencephalography , heart rate , psychiatry
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.