Article dans une revue
Frontiers in Anesthesiology
Année : 2023
Cerebral autoregulation and cerebral blood flow response to mean arterial pressure challenge following induction of general anaesthesia for neuroradiology procedure
Introduction Intraoperative hypotension is common following general anaesthesia induction with propofol, but its impact on cerebral autoregulation (CA) remains unclear. We investigate the incidence and risk factors of impaired CApost-propofol induction and its recovery after a mean arterial pressure (mAP) challenge.
Methods We included 40 non-emergency neuroradiology surgery patients [58 (47, 58)years old., 57% women]. We recorded mAP, mean blood flow velocity in the mean cerebral artery (MCAv$_{ mean}$ ), and regional cerebral oxygen saturation (rSO2). We computed the mean flow index (Mxa) pre and post mAP challenge. Mxa > 0.3 defined poor CA.
Results After anaesthesia induction, 21 (53%) had impaired CBF autoregulation (CA−, Mxa < 0.3). The average mAP was 66 ± 9 mmHg, average MCAv was 39 ± 12 cm.s$^{−1}$ , and rSO 2 was 63 ± 7%. We found no significant difference in age, norepinephrine infusion rate, and cardiovascular risks factors were similar between CA− and CA+ (Mxa ≤ 0.3) patients. Among the 22 patients (CA−: n = 14; CA+: n = 8) undergoing mAP challenge, there was a significant Mxa improvement and MCAv increase among CA− patients, (CA−: 0.63 ± 0.18 vs. 0.28 ± 0.20, p < 0.001), and [absolute variation: 1 (0.7–1.5) vs. 7 (3–9) cm.sec$^{−1}$ ], respectively.
Conclusion After induction of general anaesthesia for neuroradiology procedure, 53% of the patients had an impaired CA, regardless of age or medical history. Importantly, a mAP challenge effectively restored CA and improved CBF. Clinical Trial Registration identifier, NCT04288869
Introduction Intraoperative hypotension is common following general anaesthesia induction with propofol, but its impact on cerebral autoregulation (CA) remains unclear. We investigate the incidence and risk factors of impaired CApost-propofol induction and its recovery after a mean arterial pressure (mAP) challenge.
Methods We included 40 non-emergency neuroradiology surgery patients [58 (47, 58)years old., 57% women]. We recorded mAP, mean blood flow velocity in the mean cerebral artery (MCAv$_{ mean}$ ), and regional cerebral oxygen saturation (rSO2). We computed the mean flow index (Mxa) pre and post mAP challenge. Mxa > 0.3 defined poor CA.
Results After anaesthesia induction, 21 (53%) had impaired CBF autoregulation (CA−, Mxa < 0.3). The average mAP was 66 ± 9 mmHg, average MCAv was 39 ± 12 cm.s$^{−1}$ , and rSO 2 was 63 ± 7%. We found no significant difference in age, norepinephrine infusion rate, and cardiovascular risks factors were similar between CA− and CA+ (Mxa ≤ 0.3) patients. Among the 22 patients (CA−: n = 14; CA+: n = 8) undergoing mAP challenge, there was a significant Mxa improvement and MCAv increase among CA− patients, (CA−: 0.63 ± 0.18 vs. 0.28 ± 0.20, p < 0.001), and [absolute variation: 1 (0.7–1.5) vs. 7 (3–9) cm.sec$^{−1}$ ], respectively.
Conclusion After induction of general anaesthesia for neuroradiology procedure, 53% of the patients had an impaired CA, regardless of age or medical history. Importantly, a mAP challenge effectively restored CA and improved CBF. Clinical Trial Registration identifier, NCT04288869
Titre
en
Cerebral autoregulation and cerebral blood flow response to mean arterial pressure challenge following induction of general anaesthesia for neuroradiology procedure
2
PARIETAL -
Modelling brain structure, function and variability based on high-field MRI data
( 56051 )
- Neurospin, CEA Saclay, Bâtiment 145, 91191 Gif-sur-Yvette Cedex
- France
Service NEUROSPIN ( 40417 )
;
Université Paris-Saclay ( 419361 )
;
Institut des Sciences du Vivant Frédéric JOLIOT ( 487603 )
;
Commissariat à l'énergie atomique et aux énergies alternatives DRF ( 300016 )
Inria Saclay - Ile de France ( 118511 )
;
Institut National de Recherche en Informatique et en Automatique ( 300009 )
3
Service d'Anesthésie-Réanimation [AP-HP Hôpitaux Saint-Louis Lariboisière]
( 500632 )
- rue Ambroise Paré, 75010 Paris
- France
Assistance publique - Hôpitaux de Paris (AP-HP) ( 300068 )
;
Assistance publique - Hôpitaux de Paris (AP-HP) ( 300068 )
4
AP-HP -
Assistance publique - Hôpitaux de Paris (AP-HP)
( 300068 )
- France
5
MASCOT (UMR_S_942 / U942) -
Marqueurs cardiovasculaires en situation de stress
( 1005039 )
- Hopital Lariboisière - Centre Viggo Petersen
41, Bd de la Chapelle
75475 Paris Cedex 10
- France
Institut National de la Santé et de la Recherche Médicale U942 ( 303623 )
;
Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris] ( 421654 )
;
Assistance publique - Hôpitaux de Paris (AP-HP) ( 300068 )
;
Centre National de la Recherche Scientifique UMR_S_942 ( 441569 )
;
Université Paris Cité UMR_S_942 ( 557826 )
;
Université Sorbonne Paris Nord ( 581146 )
Date de publication
2023
Page/Identifiant
1169961
Vulgarisation
Non
Comité de lecture
Oui
Audience
Internationale
Langue du document
Anglais
Nom de la revue
Frontiers in Anesthesiology
(ISSN électronique : 2813-480X)
Publié par Frontiers
Revue non référencée dans Sherpa-Romeo
Volume
2
Collaboration/Projet
ALPHABRAIN
Domaine(s)
Sciences du Vivant [q-bio]/Neurosciences [q-bio.NC]
Sciences du Vivant [q-bio]/Santé publique et épidémiologie
Mots-clés
en
cerebral autogregulation, mean arterial pressure challenge, transcranial Doppler, anesthesia, mean flow index
Elsa Manquat, Hugues Ravaux, Jihane Souilamas, Thibaut Chamoux, Jona Joaquim, et al.. Cerebral autoregulation and cerebral blood flow response to mean arterial pressure challenge following induction of general anaesthesia for neuroradiology procedure. Frontiers in Anesthesiology, 2023, 2, pp.1169961. ⟨10.3389/fanes.2023.1169961⟩. ⟨hal-04454890⟩