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Acousto-Optic Cerebral Blood Flow Monitoring During Induction of Anesthesia in Humans

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Abstract

Background

Past transcranial Doppler (TCD) studies have documented the effects of the sequence of anesthesia induction followed by intubation on cerebral blood flow (CBF) velocity. The purpose of this study was to determine whether acousto-optic CBF monitoring would detect changes in CBF which are known to occur with propofol and subsequent endotracheal intubation.

Methods

Seventy-two patients scheduled for elective non-intracranial surgery were evaluated. A Cerox 3215F (Ornim Medical) acousto-optic CBF monitor was used. The acousto-optic transducers were applied bifrontally prior to induction. Baseline cerebral flow index (CFI) values were obtained for at least 2 min prior to induction, set to a unitless value of 100. Subsequent relative changes in CFI from baseline were determined at the lowest value over 3 min after propofol injection but before laryngoscopy; and the highest value over 5 min after the start of laryngoscopy. CFI data were evaluated using Friedman’s test.

Results

The median dose of propofol [interquartile range] given was 200 mg [160–250]. CFI decreased to 84 % of baseline after propofol and increased to 147 % of baseline after endotracheal intubation (both p < 0.001); MAP decreased after intravenous induction of anesthesia from 103 ± 15 to 86 ± 15 mmHg (p < 0.001) and then returned following endotracheal intubation to 104 ± 20 mmHg.

Conclusions

Our data are congruent with previous observations made with TCD under similar experimental conditions. Such observations support the notion that acousto-optic monitoring yields valid real-time measures of changes in CBF in humans. Further validation against other quantitative measures of CBF would be appropriate.

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References

  1. Schytz HW, Guo S, Jensen LT, et al. A new technology for detecting cerebral blood flow: a comparative study of ultrasound tagged NIRS and 133Xe-SPECT. Neurocrit Care. 2012;17:139–45.

    Article  PubMed  Google Scholar 

  2. Mahan GD, Engler WE, Tiemann JJ, Uzgiris E. Ultrasonic tagging of light: theory. Proc Natl Acad Sci USA. 1998;95:14015–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Tsalach A, Metzger Y, Breskin I, Zeitak R, Shechter R. In: Ultrasound modulated light blood flow measurement using intensity autocorrelation function: A Monte-Carlo simulation. Photons Plus Ultrasound: Imaging and Sensing 2014; San Francisco, CA: SPIE, 2014.

  4. Ron A, Racheli N, Breskin I, et al. In: Measuring tissue blood flow using ultrasound modulated diffused light. Photons Plus Ultrasound: Imaging and Sensing 2012; San Francisco, CA, 2012.

  5. Kofke W, Dong M, Bloom M, Policare R, Janosky J, Sekhar L. Transcranial Doppler ultrasonography with induction of anesthesia for neurosurgery. J Neurosurg Anesthesiol. 1994;6:89–97.

    Article  CAS  PubMed  Google Scholar 

  6. Abdallah C, Karsli C, Bissonnette B. Fentanyl is more effective than remifentanil at preventing increases in cerebral blood flow velocity during intubation in children. Can J Anesth. 2002;49:1070–5.

    Article  PubMed  Google Scholar 

  7. Pierce E, Lambertsen C, Deutsch S. Cerebral circulation and metabolism during thiopental anesthesia and hyperventilation in man. J Clin Invest. 1962;41:1664–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Michenfelder J. The interdependency of cerebral functional and metabolic effects following massive doses of thiopental in the dog. Anesthesiology. 1974;41:231–6.

    Article  CAS  PubMed  Google Scholar 

  9. Kassell N, et al. Alterations in cerebral blood flow, oxygen metabolism, and-electrical activity produced by high dose sodium thiopental. Neurosurgery. 1980;1:598.

    Article  Google Scholar 

  10. Vandesteene A, Trempont V, Engelman E, et al. Effect of propofol on CBF and metabolism in man. Anaesthesia. 1988;45(Suppl):42–3.

    Article  Google Scholar 

  11. Alkire MT, Haier RJ, Barker SJ, et al. Cerebral metabolism during propofol anesthesia in humans studied with positron emission tomography. Anesthesiology. 1995;82:393–403 discussion 27A.

    Article  CAS  PubMed  Google Scholar 

  12. Oshima T, Karasawa F, Satoh T, Oshima T, Karasawa F, Satoh T. Effects of propofol on cerebral blood flow and the metabolic rate of oxygen in humans. Acta Anaesthesiol Scand. 2002;46:831–5.

    Article  CAS  PubMed  Google Scholar 

  13. Ludbrook GL, Visco E, Lam AM. Propofol: relation between brain concentrations, electroencephalogram, middle cerebral artery blood flow velocity, and cerebral oxygen extraction during induction of anesthesia. Anesthesiology. 2002;97:1363–70.

    Article  CAS  PubMed  Google Scholar 

  14. Jung HS, Sung TY, Kang H, Kim JS, Kim TY. Cerebral blood flow change during volatile induction in large-dose sevoflurane versus intravenous propofol induction: transcranial doppler study. Korean J Anesthesiol. 2014;67:323–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Engelhard K, Werner C, Möllenberg O, Kochs E. Effects of remifentanil/propofol in comparison with isoflurane on dynamic cerebrovascular autoregulation in humans. Acta Anaesthesiol Scand. 2001;45:971–6.

    Article  CAS  PubMed  Google Scholar 

  16. Harrison JM, Girling KJ, Mahajan RP. Effects of propofol and nitrous oxide on middle cerebral artery flow velocity and cerebral autoregulation. Anaesthesia. 2002;57:27–32.

    Article  CAS  PubMed  Google Scholar 

  17. Dong ML, Kofke WA, Policare RS, et al. Transcranial Doppler ultrasonography in neurosurgery: effects of intracranial tumour on right middle cerebral artery flow velocity during induction of anaesthesia. Ultrasound Med Biol. 1996;22:1163–8.

    Article  CAS  PubMed  Google Scholar 

  18. Yoo KY, Jeong CW, Kim WM, et al. Cardiovascular and arousal responses to single-lumen endotracheal and double-lumen endobronchial intubation in the normotensive and hypertensive elderly. Korean J Anesthesiol. 2011;60:90–7.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Yoo KY, Jeong CW, Jeong HJ, et al. Thiopental dose requirements for induction of anaesthesia and subsequent endotracheal intubation in patients with complete spinal cord injuries. Acta Anaesthesiol Scand. 2012;56:770–6.

    Article  CAS  PubMed  Google Scholar 

  20. Alanoǧlu Z, Tolu S, Yaļcin Ş, Batislam Y, Özatamer O, Tüzüner F. Different remifentanil doses in rapid sequence anesthesia induction: BIS monitoring and intubation conditions. Adv Clin Exp Med. 2013;22:47–55.

    PubMed  Google Scholar 

  21. Choi EM, Min KT, Lee JR, Lee TK, Choi SH. Effect of a single dose of esmolol on the bispectral index to endotracheal intubation during desflurane anesthesia. Korean J Anesthesiol. 2013;64:420–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Lee SY, Min JJ, Kim HJ, Hong DM, Kim HJ, Park HP. Hemodynamic effects of topical lidocaine on the laryngoscope blade and trachea during endotracheal intubation: a prospective, double-blind, randomized study. J Anesth. 2014;28:668–75.

    Article  PubMed  Google Scholar 

  23. Warach S, Gur RC, Gur RE, Skolnick BE, Obrist WD, Reivich M. The reproducibility of the 133Xe inhalation technique in resting studies: task order and sex related effects in healthy young adults. J Cereb Blood Flow Metab. 1987;7:702–8.

    Article  CAS  PubMed  Google Scholar 

  24. Kofke WA, Brauer P, Policare R, Penthany S, Barker D, Horton J. Middle cerebral artery blood flow velocity and stable xenon-enhanced computed tomographic blood flow during balloon test occlusion of the internal carotid artery. Stroke. 1995;26:1603–6.

    Article  CAS  PubMed  Google Scholar 

  25. Brauer P, Kochs E, Werner C, et al. Correlation of transcranial Doppler sonography mean flow velocity with cerebral blood flow in patients with intracranial pathology. J Neurosurg Anesthesiol. 1998;10:80–5.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This work was supported by a Grant from Ornim Ltd, 15 Atir Yeda St., Kfar Saba, Israel 4464312.

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Authors and Affiliations

  1. Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, USA

    Marlon Schwarz, Giovanni Rivera, Mary Hammond, Kirk Jackson & W. Andrew Kofke

  2. Ornim Medical Ltd, 15 Atir Yeda St., Kfar Saba, Israel, 4464312

    Zmira Silman

  3. Department of Neurosurgery, University of Pennsylvania, 7 Dulles Building, 3400 Spruce St, Philadelphia, PA, 19104-4283, USA

    W. Andrew Kofke

Authors
  1. Marlon Schwarz
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  2. Giovanni Rivera
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  3. Mary Hammond
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  4. Zmira Silman
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  5. Kirk Jackson
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  6. W. Andrew Kofke
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Corresponding author

Correspondence to W. Andrew Kofke.

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Conflict of interest

Marlon Schwarz, Giovanni Rivera, Mary Hammond, and Kirk Jackson declare that they have no conflicts of interest. Zmira Silman is an employee of Ornim Medical Ltd. W. Andrew Kofke has received funding for the present study from Ornim Medical Ltd.

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Schwarz, M., Rivera, G., Hammond, M. et al. Acousto-Optic Cerebral Blood Flow Monitoring During Induction of Anesthesia in Humans. Neurocrit Care 24, 436–441 (2016). https://doi.org/10.1007/s12028-015-0201-2

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  • DOI: https://doi.org/10.1007/s12028-015-0201-2

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