scholarly journals Effect of intensive versus standard blood pressure control on cerebral blood flow in SPRINT

2020 ◽  
Vol 16 (S4) ◽  
Author(s):  
Sudipto Dolui ◽  
John A. Detre ◽  
Monique E. Cho ◽  
William E. Haley ◽  
Lenore J. Launer ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Blood Pressure Control ◽  
Pressure Control

POSTCAROTID ENDARTERECTOMY CEREBRAL HYPERPERFUSION CAN BE PREVENTED BY MINIMIZING INTRAOPERATIVE CEREBRAL ISCHEMIA AND STRICT POSTOPERATIVE BLOOD PRESSURE CONTROL UNDER CONTINUOUS SEDATION

Neurosurgery ◽  
2009 ◽  
Vol 64 (3) ◽  
pp. 447-454 ◽  
Author(s):  
Takakazu Kawamata ◽  
Yoshikazu Okada ◽  
Akitsugu Kawashima ◽  
Taku Yoneyama ◽  
Kohji Yamaguchi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Cerebral Ischemia ◽  
Blood Pressure Control ◽  
Internal Carotid ◽  
Pressure Control ◽  
Cerebral Hyperperfusion Syndrome ◽  
Cerebral Hyperperfusion ◽  
Continuous Sedation

Abstract OBJECTIVE Cerebral hyperperfusion syndrome is a major complication after carotid endarterectomy (CEA). We investigated whether our strategy of minimizing intraoperative cerebral ischemia and strict postoperative blood pressure control under continuous sedation prevented postoperative hyperperfusion. METHODS Eighty consecutive patients undergoing CEA were studied. A shunt was used in all patients during CEA. All patients were managed postoperatively under continuous sedation for as long as 48 hours on the basis of the regional cerebral blood flow (rCBF) measured immediately after CEA. Postoperative hyperperfusion was assessed, on the basis of the cerebral blood flow study under sedation (propofol) after CEA, either as a greater than 30% increase in rCBF compared with the contralateral side, or a greater than 100% increase in the corrected rCBF (calculated from percentage reduction of the contralateral rCBF induced by propofol) compared with preoperative values. RESULTS No patient developed cerebral hyperperfusion syndrome. Postoperative hyperperfusion was found at very low rates (2.5% in the middle cerebral artery territory and 1.3% in the anterior cerebral artery territory by definition 1, and 0% in both territories by definition 2). Ratios of regional oxygen saturation after internal carotid artery clamping to preclamp baseline values were greater than 0.9 in 78 of 80 patients, indicating very mild intraoperative cerebral ischemia. Parameters related to cerebral ischemia during CEA, such as regional oxygen saturation, internal carotid artery cross-clamping duration, and stump pressure (index), did not affect the incidence of postoperative hyperperfusion. CONCLUSION The present study suggests that minimizing intraoperative cerebral ischemia using a shunt, followed by strict postoperative blood pressure control under continuous sedation, can prevent post-CEA hyperperfusion.

scholarly journals Effect of Standard vs Intensive Blood Pressure Control on Cerebral Blood Flow in Small Vessel Disease

2018 ◽  
Vol 75 (6) ◽  
pp. 720 ◽  
Author(s):  
Iain D. Croall ◽  
Daniel J. Tozer ◽  
Barry Moynihan ◽  
Usman Khan ◽  
John T. O’Brien ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Blood Pressure Control ◽  
Small Vessel Disease ◽  
Pressure Control ◽  
Small Vessel ◽  
Vessel Disease ◽  
Intensive Blood Pressure

scholarly journals Intensive Blood Pressure Control Affects Cerebral Blood Flow in Type 2 Diabetes Mellitus Patients

Hypertension ◽  
2011 ◽  
Vol 57 (4) ◽  
pp. 738-745 ◽  
Author(s):  
Yu-Sok Kim ◽  
Shyrin C.A.T. Davis ◽  
Jasper Truijen ◽  
Wim J. Stok ◽  
Niels H. Secher ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Blood Flow ◽  
Type 2 Diabetes Mellitus ◽  
Cerebral Blood Flow ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Intensive Blood Pressure

Significance of Quantitative Cerebral Blood Flow Measurement in the Acute Stage after Revascularization Surgery for Adult Moyamoya Disease: Implication for the Pathological Threshold of Local Cerebral Hyperperfusion

2019 ◽  
Vol 48 (3-6) ◽  
pp. 217-225 ◽  
Author(s):  
Masayuki Kameyama ◽  
Miki Fujimura ◽  
Ryosuke Tashiro ◽  
Kenichi Sato ◽  
Hidenori Endo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Intracerebral Hemorrhage ◽  
Perioperative Management ◽  
Pressure Control ◽  
Acute Stage ◽  
Cerebral Hyperperfusion ◽  
Auc Value ◽  
Revascularization Surgery

Objective: Superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis is a standard surgical procedure for adult patients with moyamoya disease (MMD) and plays a role in preventing ischemic and/or hemorrhagic stroke. Cerebral hyperperfusion (CHP) syndrome is a potential complication of this procedure that can result in deleterious outcomes, such as delayed intracerebral hemorrhage, but the exact threshold of the pathological increase in postoperative cerebral blood flow (CBF) is unclear. Thus, we analyzed local CBF in the acute stage after revascularization surgery for adult MMD to predict CHP syndrome under modern perioperative management. Materials and Methods: Fifty-nine consecutive adult MMD patients, aged 17–66 years old (mean 43.1), underwent STA-MCA anastomosis with indirect pial synangiosis for 65 affected hemispheres. All patients were perioperatively managed by strict blood pressure control (systolic pressure of 110–130 mm Hg) to prevent CHP syndrome. Local CBF at the site of anastomosis was quantitatively measured using the autoradiographic method by N-isopropyl-p-[123I] iodoamphetamine single-photon emission computed tomography 1 and 7 days after surgery, in addition to the preoperative CBF value at the corresponding area. We defined CHP phenomenon as a local CBF increase over 150% compared to the preoperative value. Then, we investigated the correlation between local hemodynamic change and the development of CHP syndrome. Results: After 65 surgeries, 5 patients developed CHP syndrome, including 2 patients with delayed intracerebral hemorrhage (3.0%), 1 with symptomatic subarachnoid hemorrhage (1.5%), and 2 with focal neurological deterioration without hemorrhage. The CBF increase ratio was significantly higher in patients with CHP syndrome (270.7%) than in patients without CHP syndrome (135.2%, p = 0.003). Based on receiver operating characteristic analysis, the cutoff value for the pathological postoperative CBF increase ratio was 184.5% for CHP syndrome (sensitivity = 83.3%, specificity =  94.2%, area under the curve [AUC] value  =  0.825) and 241.3% for hemorrhagic CHP syndrome (sensitivity =  75.0%, specificity =  97.2%, AUC value  =  0.742). Conclusion: Quantitative measurement of the local CBF value in the early postoperative period provides essential information to predict CHP syndrome after STA-MCA anastomosis in patients with adult MMD. The pathological threshold of hemorrhagic CHP syndrome was as high as 241.3% by the local CBF increase ratio, but 2 patients (3.0%) developed delayed intracerebral hemorrhage in this series that were managed following the intensive perioperative management protocol. Thus, we recommend routine CBF measurement in the acute stage after direct revascularization surgery for adult MMD and satisfactory blood pressure control to avoid the deleterious effects of CHP.

Neurological: Cerebral Aneurysm

2018 ◽  
pp. 161-168
Author(s):  
Sergey Pisklakov
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysm ◽  
Pressure Control ◽  
Aneurysm Clipping ◽  
Intraoperative Management ◽  
Cardiac Assessment ◽  
Triple H

In this chapter the essential aspects of anesthesia for resection of a cerebral aneurysm are discussed. Subtopics include the different types of aneurysms and strategies for preventing rupture, including nimodipine use and triple H therapy. The case presented involves a patient emergently scheduled for subarachnoid hemorrhage evacuation and intracranial aneurysm clipping. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Preoperative topics discussed are neurological and cardiac assessment, including cerebral blood flow and how hypertension affects anesthetic preparation. Issues regarding intraoperative management include induction, monitors used, and blood pressure control. Postoperative concerns addressed include rebleeding and vasospasm and hyponatremia.

Cerebral blood flow and metabolism in severely head-injured children

1989 ◽  
Vol 71 (1) ◽  
pp. 72-76 ◽  
Author(s):  
J. Paul Muizelaar ◽  
John D. Ward ◽  
Anthony Marmarou ◽  
Pauline G. Newlon ◽  
Akihiko Wachi
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Pressure Control ◽  
Acute Stage ◽  
Volume Index ◽  
Content Type ◽  
Lower Blood ◽  
Head Injured ◽  
Gcs Score

✓ Autoregulation of cerebral blood flow (“CBF15”) was tested in a series of 26 pediatric patients (mean age 13.2 years) with severe head injury (average Glasgow Coma Scale (GCS) score 5.5) in the acute stage. A baseline 133Xe CBF measurement was performed and then repeated, after blood pressure was increased by 29% with intravenous phenylephrine or decreased by 26% with intravenous trimethaphan camsylate. Correlations were made between CBF and clinical condition, outcome, time after injury, intracranial pressure (ICP), and pressure-volume index (PVI) changes, and the site of injury (hemispheres, diencephalon, or brain stem). The site of injury was determined with multimodality evoked potential measurements. Autoregulation was intact in 22 (59%) of 37 measurements. There was no correlation with GCS score, outcome, time after injury, site of injury, or way of testing (decreasing or increasing blood pressure). Autoregulation was statistically significantly more often impaired when CBF was either below normal −2 standard deviations (SD) (reduced flow) or above normal +2 SD (absolute hyperemia). In cases with intact autoregulation, mean ICP decreased from 17.5 to 15.0 mm Hg with higher blood pressure and increased from 19.0 to 21.3 mm Hg with lower blood pressure. When PVI was measured during the blood pressure manipulations, it was found to change in a direction opposite to the ICP change. The consequences of these findings in the management of ICP problems with blood pressure control are discussed.

Patterns of Cerebral Blood Flow and Systemic Hemodynamics During Arithmetic Processing

2008 ◽  
Vol 22 (2) ◽  
pp. 81-90 ◽  
Author(s):  
Natalie Werner ◽  
Neval Kapan ◽  
Gustavo A. Reyes del Paso
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Time Course ◽  
Doppler Sonography ◽  
Transcranial Doppler Sonography ◽  
Systemic Hemodynamics ◽  
Heart Period ◽  
Blood Flow Velocities ◽  
Flow Velocities

The present study explored modulations in cerebral blood flow and systemic hemodynamics during the execution of a mental calculation task in 41 healthy subjects. Time course and lateralization of blood flow velocities in the medial cerebral arteries of both hemispheres were assessed using functional transcranial Doppler sonography. Indices of systemic hemodynamics were obtained using continuous blood pressure recordings. Doppler sonography revealed a biphasic left dominant rise in cerebral blood flow velocities during task execution. Systemic blood pressure increased, whereas heart period, heart period variability, and baroreflex sensitivity declined. Blood pressure and heart period proved predictive of the magnitude of the cerebral blood flow response, particularly of its initial component. Various physiological mechanisms may be assumed to be involved in cardiovascular adjustment to cognitive demands. While specific contributions of the sympathetic and parasympathetic systems may account for the observed pattern of systemic hemodynamics, flow metabolism coupling, fast neurogenic vasodilation, and cerebral autoregulation may be involved in mediating cerebral blood flow modulations. Furthermore, during conditions of high cardiovascular reactivity, systemic hemodynamic changes exert a marked influence on cerebral blood perfusion.

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