Impact of hypotension on cerebral perfusion during general anesthesia induction: A prospective observational study in adults. Issue 5 (19th January 2020)

• Record Type: Journal Article
• Authors: 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
• Is Part Of: Acta anaesthesiologica scandinavica. Volume 64:Issue 5(2020:May)
• Page Start: 592
• Page End: 601
• Publication Date: 2020-01-19
• Subjects: bispectral index -- cerebral oximetry -- general anesthesia -- hypotension -- transcranial doppler; Anesthesiology -- Periodicals; Critical care medicine -- Periodicals; 617.9605
• DOI: 10.1111/aas.13537
• Languages: English
• ISSNs: 0001-5172

Abstract

Abstract : 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.