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Br J Anaesth. 2018 Dec;121(6):1308-1315. doi: 10.1016/j.bja.2018.07.041. Epub 2018 Oct 10.

Effects of moderate and severe arterial hypotension on intracerebral perfusion and brain tissue oxygenation in piglets.

Author information

1
Section of Anaesthesiology, Vetsuisse Faculty University of Zurich, Zurich, Switzerland. Electronic address: sringer@vetclinics.uzh.ch.
2
Department of Anaesthesiology, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Centre, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland; Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark.
3
Department of Anaesthesiology, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Centre, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland.
4
Clinic of Diagnostic Imaging, Vetsuisse Faculty University of Zurich, Zurich, Switzerland.
5
Section of Anaesthesiology, Vetsuisse Faculty University of Zurich, Zurich, Switzerland.

Abstract

BACKGROUND:

Hypotension is common in anaesthetised children, and its impact on cerebral oxygenation is unknown. The goal of the present study was to investigate the effects of moderate systemic arterial hypotension (mHT) and severe hypotension (sHT) on cerebral perfusion and brain tissue oxygenation in piglets.

METHODS:

Twenty-seven anaesthetised piglets were randomly allocated to a control group, mHT group, or sHT group. Cerebral monitoring comprised a tissue oxygen partial pressure ( [Formula: see text] ) and laser Doppler (LD) perfusion probe advanced into the brain tissue, and a near-infrared spectroscopy sensor placed over the skin measuring regional oxygen saturation (rSO2). Arterial hypotension was induced by blood withdrawal and i.v. nitroprusside infusion [target MAP: 35-38 (mHT) and 27-30 (sHT) mm Hg]. Data were analysed at baseline, and every 20 min during and after treatment.

RESULTS:

Compared with control, [Formula: see text] decreased equally with mHT and sHT [mean (SD) after 60 min: control: 17.1 (6.4); mHT: 6.4 (3.6); sHT: 7.2 (4.3) mm Hg]. No differences between groups were detected for rSO2 and LD during treatment. However, in the sHT group, rSO2 increased after restoring normotension [from 49.3 (9.5) to 58.9 (8.9)% Post60]. sHT was associated with an increase in blood lactate [from 1.5 (0.4) to 2.4 (0.9) mmol L-1], and a decrease in bicarbonate [28 (2.4) to 25.8 (2.6) mmol L-1] and base excess [4.7 (1.9) to 2.0 (2.7) mmol L-1] between baseline and 60 min after the start of the experiment.

CONCLUSIONS:

Induction of mHT and sHT by hypovolaemia and nitroprusside infusion caused alterations in brain tissue oxygenation in a piglet model, but without detectable changes in brain tissue perfusion and regional oxygen saturation.

KEYWORDS:

anesthesia; cerebral autoregulation; cerebral blood flow; hypoxia; near-infrared spectroscopy; nitroprusside; vascular hypotension

PMID:
30442258
DOI:
10.1016/j.bja.2018.07.041
[Indexed for MEDLINE]

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