Stefano Arrigoni-Marocco1, Nicolas Engrand2, Vittorio Civelli3, Joaquim Mateo4,5, Marc-Antoine Labeyrie3, Jean-Pierre Saint-Maurice3, Alexandre Mebazaa4,5,6, Etienne Gayat4,5,6, Emmanuel Houdart5,3, Fabrice Vallée4,5,6,7. 1. Department of Anesthesia, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis - Lariboisière, Assistance Publique - Hôpitaux de Paris, 2, rue Ambroise Paré, 75010, Paris, France. s.arrigonim@gmail.com. 2. Anaesthesia and Intensive Care Division, Fondation Rothschild, 25 rue Manin, 75019, Paris, France. 3. Interventional Neuroradiology Unit, Hôpitaux Universitaires Saint Louis - Lariboisière, Assistance Publique - Hôpitaux de Paris, 2, rue Ambroise Paré, 75010, Paris, France. 4. Department of Anesthesia, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis - Lariboisière, Assistance Publique - Hôpitaux de Paris, 2, rue Ambroise Paré, 75010, Paris, France. 5. Paris Diderot University, Paris, France. 6. UMR-S 942, INSERM, Paris, France. 7. LMS, Ecole Polytechnique, M3DISIM, Inria, CNRS, Université Paris-Saclay, Saint-Aubin, France.
Abstract
INTRODUCTION: Transcranial Doppler (TCD) of the middle cerebral artery (MCA) enables the measurement of the mean blood velocity (MCAVm) and the estimation of the cerebral blood flow (CBF), provided that no significant changes occur in the MCA diameter (MCADiam). Previous studies described a decrease in the MCAVm associated with the induction of total intravenous anesthesia (TIVA) by propofol and remifentanil. This decrease in blood velocity might be interpreted as a decrease in the CBF only where the MCADiam is not modified across TCD examinations. METHODS: In this observational study, we measured the MCADiam of 24 subjects (almost exclusively females) on digital subtraction angiography under awake and TIVA conditions. RESULTS: Across the two phases, we observed a decrease in the mean arterial blood pressure (from 84 ± 9 to 71 ± 6 mmHg; p < 0.001) and heart rate (76 ± 10 vs. 65 ± 8 beats/min; p < 0.001), and a concomitant decrease in the MCAVm (61 vs. 42 cm/s; p < 0.001). In contrast, the MCADiam did not vary in association with TIVA (2.3 ± 0.2 vs. 2.3 ± 0.2 mm; p = 0.52). CONCLUSIONS: Those results suggested that in this population, no significant changes in the MCADiam are associated with TIVA.
INTRODUCTION: Transcranial Doppler (TCD) of the middle cerebral artery (MCA) enables the measurement of the mean blood velocity (MCAVm) and the estimation of the cerebral blood flow (CBF), provided that no significant changes occur in the MCA diameter (MCADiam). Previous studies described a decrease in the MCAVm associated with the induction of total intravenous anesthesia (TIVA) by propofol and remifentanil. This decrease in blood velocity might be interpreted as a decrease in the CBF only where the MCADiam is not modified across TCD examinations. METHODS: In this observational study, we measured the MCADiam of 24 subjects (almost exclusively females) on digital subtraction angiography under awake and TIVA conditions. RESULTS: Across the two phases, we observed a decrease in the mean arterial blood pressure (from 84 ± 9 to 71 ± 6 mmHg; p < 0.001) and heart rate (76 ± 10 vs. 65 ± 8 beats/min; p < 0.001), and a concomitant decrease in the MCAVm (61 vs. 42 cm/s; p < 0.001). In contrast, the MCADiam did not vary in association with TIVA (2.3 ± 0.2 vs. 2.3 ± 0.2 mm; p = 0.52). CONCLUSIONS: Those results suggested that in this population, no significant changes in the MCADiam are associated with TIVA.
Entities:
Keywords:
Cerebral blood flow; Digital subtraction angiography; General anesthesia; Middle cerebral artery; Transcranial Doppler