Continuous monitoring of cerebral blood flow during general anaesthesia in infants
Background: General anaesthesia is associated with neurocognitive deficits in infants after noncardiac surgery. Disturbances in cerebral perfusion as a result of systemic hypotension and impaired autoregulation may be a potential cause. Our aim was to study cerebral blood flow (CBF) velocity continu...
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| Format: | Article |
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Elsevier
2023-06-01
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| Series: | BJA Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772609623000230 |
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| author | Sigrid D. Vik Hans Torp Anders H. Jarmund Gabriel Kiss Turid Follestad Ragnhild Støen Siri Ann Nyrnes |
| author_facet | Sigrid D. Vik Hans Torp Anders H. Jarmund Gabriel Kiss Turid Follestad Ragnhild Støen Siri Ann Nyrnes |
| author_sort | Sigrid D. Vik |
| collection | DOAJ |
| description | Background: General anaesthesia is associated with neurocognitive deficits in infants after noncardiac surgery. Disturbances in cerebral perfusion as a result of systemic hypotension and impaired autoregulation may be a potential cause. Our aim was to study cerebral blood flow (CBF) velocity continuously during general anaesthesia in infants undergoing noncardiac surgery and compare variations in CBF velocity with simultaneously measured near-infrared spectroscopy (NIRS), blood pressure, and heart rate. Methods: NeoDoppler, a recently developed ultrasound system, was used to monitor CBF velocity via the anterior fontanelle during induction and maintenance of general anaesthesia until the start of surgery, and during recovery. NIRS, blood pressure, and heart rate were monitored simultaneously and synchronised with the NeoDoppler measurements. Results: Thirty infants, with a median postmenstrual age at surgery of 37.6 weeks (range 28.6–60.0) were included. Compared with baseline, the trend curves showed a decrease in CBF velocity during induction and maintenance of anaesthesia and returned to baseline values during recovery. End-diastolic velocity decreased in all infants during anaesthesia, on average by 59%, whereas peak systolic- and time-averaged velocities decreased by 26% and 45%, respectively. In comparison, the reduction in mean arterial pressure was only 20%. NIRS values were high and remained stable. When adjusting for mean arterial pressure, the significant decrease in end-diastolic velocity persisted, whereas there was only a small reduction in peak systolic velocity. Conclusions: Continuous monitoring of CBF velocity using NeoDoppler during anaesthesia is feasible and may provide valuable information about cerebral perfusion contributing to a more targeted haemodynamic management in anaesthetised infants. |
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| format | Article |
| id | doaj.art-8fd5bb7a755e4c868b1421840462234f |
| institution | Directory Open Access Journal |
| issn | 2772-6096 |
| language | English |
| last_indexed | 2024-03-13T03:56:04Z |
| publishDate | 2023-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | BJA Open |
| spelling | doaj.art-8fd5bb7a755e4c868b1421840462234f2023-06-22T05:06:05ZengElsevierBJA Open2772-60962023-06-016100144Continuous monitoring of cerebral blood flow during general anaesthesia in infantsSigrid D. Vik0Hans Torp1Anders H. Jarmund2Gabriel Kiss3Turid Follestad4Ragnhild Støen5Siri Ann Nyrnes6Children's Clinic, St. Olavs University Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Corresponding author. Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, NorwayDepartment of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, NorwayDepartment of Computer Science, Norwegian University of Science and Technology (NTNU), Trondheim, NorwayClinical Research Unit Central Norway, St. Olavs Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, NorwayChildren's Clinic, St. Olavs University Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, NorwayChildren's Clinic, St. Olavs University Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, NorwayBackground: General anaesthesia is associated with neurocognitive deficits in infants after noncardiac surgery. Disturbances in cerebral perfusion as a result of systemic hypotension and impaired autoregulation may be a potential cause. Our aim was to study cerebral blood flow (CBF) velocity continuously during general anaesthesia in infants undergoing noncardiac surgery and compare variations in CBF velocity with simultaneously measured near-infrared spectroscopy (NIRS), blood pressure, and heart rate. Methods: NeoDoppler, a recently developed ultrasound system, was used to monitor CBF velocity via the anterior fontanelle during induction and maintenance of general anaesthesia until the start of surgery, and during recovery. NIRS, blood pressure, and heart rate were monitored simultaneously and synchronised with the NeoDoppler measurements. Results: Thirty infants, with a median postmenstrual age at surgery of 37.6 weeks (range 28.6–60.0) were included. Compared with baseline, the trend curves showed a decrease in CBF velocity during induction and maintenance of anaesthesia and returned to baseline values during recovery. End-diastolic velocity decreased in all infants during anaesthesia, on average by 59%, whereas peak systolic- and time-averaged velocities decreased by 26% and 45%, respectively. In comparison, the reduction in mean arterial pressure was only 20%. NIRS values were high and remained stable. When adjusting for mean arterial pressure, the significant decrease in end-diastolic velocity persisted, whereas there was only a small reduction in peak systolic velocity. Conclusions: Continuous monitoring of CBF velocity using NeoDoppler during anaesthesia is feasible and may provide valuable information about cerebral perfusion contributing to a more targeted haemodynamic management in anaesthetised infants.http://www.sciencedirect.com/science/article/pii/S2772609623000230brain injurycerebral perfusiongeneral anaesthesiainfantsmultimodal monitoring |
| spellingShingle | Sigrid D. Vik Hans Torp Anders H. Jarmund Gabriel Kiss Turid Follestad Ragnhild Støen Siri Ann Nyrnes Continuous monitoring of cerebral blood flow during general anaesthesia in infants BJA Open brain injury cerebral perfusion general anaesthesia infants multimodal monitoring |
| title | Continuous monitoring of cerebral blood flow during general anaesthesia in infants |
| title_full | Continuous monitoring of cerebral blood flow during general anaesthesia in infants |
| title_fullStr | Continuous monitoring of cerebral blood flow during general anaesthesia in infants |
| title_full_unstemmed | Continuous monitoring of cerebral blood flow during general anaesthesia in infants |
| title_short | Continuous monitoring of cerebral blood flow during general anaesthesia in infants |
| title_sort | continuous monitoring of cerebral blood flow during general anaesthesia in infants |
| topic | brain injury cerebral perfusion general anaesthesia infants multimodal monitoring |
| url | http://www.sciencedirect.com/science/article/pii/S2772609623000230 |
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