Thorac cardiovasc Surg 1999; 47(6): 381-385
DOI: 10.1055/s-2007-1013178
Original Vascular

© Georg Thieme Verlag Stuttgart · New York

Systemic Blood Pressure and Cerebral Blood Flow Velocity During Carotid Surgery

G. Grubhofer1 , A. Lassnigg1 , T. Pernerstorfer1 , O. Ipsiroglu2 , M. Czerny3 , P. Polterauer3 , M. Hiesmayr1
  • 1Department of Cardiothoracic and Vascular Anesthesia and Intensive Care
  • 2Department of Neonatology, Inborn Errors, and Pediatric Intensive Care
  • 3Department of Vascular Surgery, University Hospital, Vienna, Austria
Further Information

Publication History

1998

Publication Date:
19 March 2008 (online)

Abstract

Background: To evaluate the effect of mean arterial blood pressure (MAP) on cerebral perfusion during carotid surgery, we investigated blood flow velocity in the middle cerebral (Vs,mca) using transcranial Doppler ultrasonography (TCD). Methods: During carotid crossclamping, treatment included either phenylephrine-induced hypertension without shunting (Group XC; n = 11) or insertion of a shunt (Group S; n = 12). Results: Increasing MAP in Group XC before crossclamping (81 ± 13 mmHg to 107 ± 12 mmHg) caused an increase of Vs,mca (59 ± 17 cm/s to 75 ± 20 cm/s; p < 0.001). During crossclamping without a shunt, Vs,mca was not dependent on MAP, and was reduced (mean 47 ± 24 cm/s) in relation to preclamp values. In Group S, Vs,mca was always dependent on MAP and the preclamp velocity was maintained (before shunt: 75 ± 26 cm/sec; during shunt: 79 ± 30 cm/sec). Conclusions: Although we found an impaired cerebral autoregulation, /s,mca was independent of MAP during carotid crossclamping. Thus, TCD measurements have to be interpreted with caution during crossclamping, and the effect of induced hypertension has to be confirmed with more invasive measures of cerebral blood flow.