Correlation between mean arterial pressure (MAP) and brain saturation (rSO2) in patients undergoing moderate hypotensive anesthesia for septo- and rhinoplastic surgery
- hypotensive anesthesia,
- brain oxygenation,
- general anesthesia,
How to Cite
Hypotensive anesthesia is such anesthetic technique where during general anesthesia the patient's mean arterial pressure is decreased by more than 20% of its preoperative value. Motivation: To prevent the occurrence of brain hypoxia during hypotensive anesthesia in patients undergoing septo- and rhinoplastic surgery. Aims: To determine the average values of brain saturation in awaken patients; to find the correlation between the mean arterial pressure and brain saturation during moderate hypotension, and to analyze the adverse reactions postoperatively. Materials and methods: Twenty (ASA 1) patients, anaesthetised in moderate hypotensive general anesthesia with Remifentanyl and Sevoflurane were enrolled in the study. They were observed at five times interval (T1-5): MAP, HR and rSO2, and a correlation between the parameters was determined. Results: A moderate hypotension was achieved in T4 (MAP = 69.05 ± 7.09). The average baseline values of brain saturation from 73.30 ± 5.44% to the left, 75.30 ± 5.18% to the right brain hemisphere were obtained. The curve of brain saturation had an upward trend, a peak that coincided with an introduction to anesthesia, in a further course with a downward trend. We found a mild to moderate positive correlation between MAP and rSO2 during hypotensive anesthesia, but throughout the entire period there was a higher rSO2 than the basal initial value. Conclusion: Moderate hypotension and stable mean arterial pressure (MAP) contribute to stable brain saturation (rSO2).
- Rodrigo C. Induced hypotension during anesthesia with special reference to orthognathiс surgery. Anesth Prog 1995;42(2):41-5.
- Enderly GEH. Controlled Hypotension.Anesthesia. 1960;15:25-32.
- Fromme GA, MacKenzie RA, Gould Jr AB,Lund BA,Offord K.Controlled hypotension for orthognathic surgery. Anesth & Analges 1986;65(6):683-86
- Patel NJ,Patel BS,Paskin S,Laufer S. Induced moderate hypotensive anesthesia for spinal fusion and Harrington-rod instrumentation. J Bone Joint Surg Am 1985;67(9):1384-87
- Barak M,Yoav L, Abu el-Naaj I. Hypotensive Anesthesia versus Normotensive Anesthesia during Major Maxillofacial Surgery: A Review of the Literature. The Scientific World Journal. 2015; 1-7
- Albera R et al. Cochlear blood flow modifications induced by anaesthetic drugs in middle ear surgery: comparison between sevoflurane and propofol. Acta oto-laryngologica 2003; 123(7):812-16
- Eberhart LH, Folz BJ, Wulf H, Geldner G. Intravenous anesthesia provides optimal surgical conditions during microscopic and endoscopic sinus surgery. The Laryngoscope 2003; 113(8):1369-73
- Seruya M et al. Controlled hypotension and blood loss during frontoorbital advancement: Clinical article. Journal of Neurosurgery 2012;9(5):491-96
- Činčikas D, Ivaškevičius J. Application of controlled arterial hypotension in endoscopic rhinosurgery. Medicina 2003;39(9):852-59
- Shirgoska B. Hipotensive anesthesia. Skopje, Ph Thesis, Faculty of Medicine, Saints Cyril and Methodius University of Skopje, Skopje, 2012
- Degoute CS. Controlled hypotension. Drugs 2007; 67:1053-76
- Vilkė A. Near-infrared spectroscopy as an index of brain and tissue oxygenation. Health Sciences 2011;21:143-151
- Murkin JM, Arango M. Near-infrared spectroscopy as an index of brain and tissue oxygenation. Br J of anaesth 2009;103: i3-i13
- Soeding PF, Wang J, Hoy G, Jarman P, Phillips H, Marks P, Royse C. The effect of the sitting upright or 'beachchair' position on cerebral blood flow during anaesthesia for shoulder surgery. Anaesth Intensive Care 2011;39(3):440-8
- Bouma GJ, Muize JP. Relationship between cardiac output and cerebral blood flow in patients with intact and with impaired autoregulation. J of Neurosurgery 1990;73(3):368-374
- Rosner MJ, Daughton S. Cerebral perfusion pressure management in head injury. J Trauma 1990;30:933-941
- Hernandez-Meza G, Izzetoglu M, Osbakken M. Near-Infrared spectroscopy for the evaluation of anesthetic depth. BioMed research international 2015;Id939418:11p
- Pollard V, Prough DS, DeMelo AE, Deyo DJ, Uchida T, Stoddart HF. Validation in volunteers of a near-infrared spectroscope for monitoring brain oxygenation in vivo. Anesth Analg1996;82:269-277
- Ferrari M, Giannini I, Sideri G, Zanette E. Continuous non invasive monitoring of human brain by near infrared spectroscopy. Oxygen Transport to Tissue VII 1985;191:872-882
- Casati A, Fanelli G, Pietropaoli P, Proietti R, Tufano R, Danelli G, et al. Continuous monitoring of cerebral oxygen saturation in elderly patients undergoing major abdominal surgery minimizes brain exposure to potential hypoxia. Anesth Analg 2005;101(3):740-747
- Janelle GM, Mnookin S, Gravenstein N, Martin TD, Urdaneta F. Unilateral
- cerebral oxygen desaturation during emergent repair of a DeBakey type 1 aortic dissection: potential aversion of a major catastrophe. Anesthesiology 2002;96:1263-1265.
- Blas ML, Lobato EB, Martin T. Noninvasive infrared spectroscopy as a monitor of retrograde cerebral perfusion during deep hypothermia. J of cardiothoracic and vascular anesth 1999;13(2):244-245
- Ohmae E, Ouchi Y, Oda M, Suzuki T, Nobesawa S, Kanno T et al. Cerebral hemodynamics evaluation by near-infrared time-resolved spectroscopy: correlation with simultaneous positron emission tomography measurements. Neuroimage 2006; 29(3):697-705
- Cullen DJ,Kirby RR. Beach chair position may decrease cerebral perfusion: catastrophic outcomes have occurred. APSF newsletter 2007; 22(2):25-27
- Pollard V, Prough DS, De Melo AE, Deyo DJ. The influence of carbon dioxide and body position on near infrared spectroscopic assessment of cerebral hemoglobin oxygen saturation. Anesth Analg 1996;82(2):278-287
- Han SH, Ham BM, Oh YS, Bahk JH. The effect of acute normovolemic haemodilution on cerebral oxygenation. International journal of clinical practice 2004; 58(10):903-906
- Naidech AM, Bendok BR, Ault ML, Bleck TP. Monitoring with the Somanetics INVOS 5100C after aneurysmal subarachnoid hemorrhage. Neurocritical care 2008;9(3):326-331
- Nieman JD et al. Deep hypothermia alters the vascular response to Thiopental. Anesthesiology 2002;96:A 169
- Rosner MJ, Coley IB. Cerebral perfusion pressure, intracranial pressure, and head elevation. Journal of neurosurgery 1986;65(5):636-641
- Edmonds HL Jr, Brian LG, Erle HA lll. Cerebral oximetry for cardiac and vascular surgery, Seminars in Cardiothoracic & Vascular. Anesthesia 2004;8(2):147-166
- Strunin L. Organ perfusion during controlled hypotension. Br J Anaesth. 1975;47(7):793-8.
- Madsen PL, Nielsen HB, Christiansen P. Well-being and cerebral oxygen saturation during acute heart failure in humans. Clin Physiol 2000; 20(2):158-64
- Kim MB, Ward DS, Cartwright CR. et al. Estimation of jugular venous O2 saturation from cerebral oximetry or arterial O2 saturation during isocapnic hypoxia. Journal of clinical monitoring and computing 2000;16(3):191-199
- Kishi K, Kawaguchi M, Yoshitani K, Nagahata T, Furuya H. Influence of patient variables and sensor location on regional cerebral oxygen saturation measured by INVOS 4100 near-infrared spectrophotometers. J Neurosurg Anesthesiol 2003;15(4):302-6.
- Mishra RK, Kapoor I, Mahajan C, Prabhakar H. Reversal of trend in near infrared spectroscopy [NIRS] values in a patient with carotid artery stenosis. J Clin Anesth 2017;43:47.
- Nissen P, Van Lieshout JJ, Nielsen HB, Niels S. Frontal lobe oxygenation is maintained during hypotension following propofol-fentanyl anesthesia. AANA journal 2009; 77(4):271-276
- Lovell AT, Owen-Reece H, Elwell CE, Smith M, Goldstone JC. Continuous measurement of cerebral oxygenation by near infrared spectroscopy during induction of anesthesia. Anesth Analg 1999;88(3):554-58
- Fleck T, Schubert S, Ewert P, Stiller B, Nagdyman N, Berger F. Propofol effect on cerebral oxygenation in children with congenital heart disease. Pediatr Cardiol 2015;36(3):543-9
- Liu R, Sun D, Hang Y, et al. Evaluation of cerebral oxygen balance by cerebral oximeter and transcranial Doppler during hypothermic. Anesthesiology 1998; 89:309 (abstract).