Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.02.010
Brazilian Journal of Anesthesiology
Clinical Research

Effect of anesthesia induction on cerebral tissue oxygen saturation in hypertensive patients: an observational study

Efeito da indução anestésica na saturação de oxigênio tissular cerebral em pacientes hipertensos: estudo observacional

Yasin Taşkaldiran; Özlem Şen; Tuğba Aşkin; Süheyla Ünver

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Abstract

Objective
In hypertensive patients, the autoregulation curve shifts rightward, making these patients more sensitive than normotensive individuals to hypotension. Hypotension following the induction of anesthesia has been studied in normotensive patients to determine its effects on brain tissue oxygenation, but not enough studies have examined the effect of hypotension on brain oxygenation in hypertensive patients. The current study aimed to use near-infrared spectroscopy to evaluate brain tissue oxygen saturation after the induction of anesthesia in hypertensive patients, who may have impaired brain tissue oxygen saturation.

Methods
The study included a total of 200 patients aged > 18 years old with ASA I–III. Measurements were taken while the patient was breathing room air, after the induction of anesthesia, when the lash reflex had disappeared following the induction of anesthesia, after intubation, and in the 5th, 10th, and 15th minutes of surgery. The patients were divided into nonhypertensive and hypertensive groups.

Results
There was a significant difference in age between the groups (p =  0.000). No correlation was found between cerebral tissue oxygen saturation and age (r = 0.015, p =  0.596). Anesthesia induction was observed to decrease mean arterial blood pressure in both groups (p = 0.000). Given these changes, there was no significant difference in brain tissue oxygen saturation between the nonhypertensive and hypertensive groups (p >  0.05).

Conclusion
There was no difference between hypertensive and normotensive groups in terms of the change rates in cSO2 values. However, there was a difference between the groups in terms of cSO2 values.

Keywords

Anesthesia induction;  Cerebral tissue oxygen saturation;  Hypertension

References

1 H. Stephan, H. Sonntag, H. Schenk, et al. Effects of propofol on cardiovascular dynamics, myocardial blood flow and myocardial metabolism in patients with coronary artery disease Br J Anaesth., 58 (1986), pp. 969-975

2 N.A. Lassen Cerebral blood flow and oxygen consumption in man Physiol Rev., 39 (1959), pp. 183-238

3 M. Jaeger, M. Soehle, M. Schuhmann, et al. Correlation of continuously monitored regional cerebral blood flow and brain tissue oxygen Acta Neurochir., 147 (2005), pp. 51-56

4 S. Strandgaard, J. Olesen, E. Skinhøj, et al. Autoregulation of brain circulation in severe arterial hypertension Br Med J., 1 (1973), pp. 507-510

5 S. Strandgaard, E.T. MacKenzie, D. Sengupta, et al. Upper limit of autoregulation of cerebral blood flow in the baboon Circ Res., 34 (1974), pp. 435-440

6 S. Strandgaard, J.V. Jones, E.T. MacKenzie, et al. Upper limit of cerebral blood flow autoregulation in experimental renovascular hypertension in the baboon Circ Res., 37 (1975), pp. 164-167

7 J.V. Jones, W. Fitch, E.T. Mackenzie, et al. Lower limit of cerebral blood flow autoregulation in experimental renovascular hypertension in the baboon Circ Res., 39 (1976), pp. 555-557

8 A. Moerman, S. De Hert Recent advances in cerebral oximetry. Assessment of cerebral autoregulation with near-infrared spectroscopy: myth or reality? F1000Res., 6 (2017), pp. 1-9

9 C. Prys-Roberts, R. Meloche, P. Foex, et al. Studies of anaesthesia in relation to hypertension I: cardiovascular responses of treated and untreated patients Br J Anaesth., 43 (1971), pp. 122-137

10 L. Meng, A. Gelb, D. McDonagh Changes in cerebral tissue oxygen saturation during anaesthetic ‐ induced hypotension: an interpretation based on neurovascular coupling and cerebral autoregulation Anaesthesia., 68 (2013), pp. 736-741

11 P. Nissen, J.J. Van Lieshout, H.B. Nielsen, et al. Frontal lobe oxygenation is maintained during hypotension following propofol-fentanyl anesthesia AANA J., 77 (2009), pp. 271-276

12 G.L. Ludbrook, E. Visco, A.M. Lam, G.L. Ludbrook, E. Visco, A.M. Lam Propofol Relation between brain concentrations, electroencephalogram, middle cerebral artery blood flow velocity, and cerebral oxygen extraction during ınduction of anesthesia Anesthesiology., 97 (2002), pp. 1363-1370

13 E. Kochs, W.E. Hoffman, C. Werner, et al. The effects of propofol on brain electrical activity, neurologic outcome, and neuronal damage following incomplete ischemia in rats Anesthesiology., 76 (1992), pp. 245-252

14 M.T. Alkire, R.J. Haier, S.J. Barker, et al. Cerebral metabolism during propofol anesthesia in humans studied with positron emission tomography Anesthesiology., 82 (1995), pp. 393-403

15 S. Ederberg, A. Westerlind, E. Houltz, et al. The effects of propofol on cerebral blood flow velocity and cerebral oxygen extraction during cardiopulmonary bypass Anesth Analg., 86 (1998), pp. 1201-1206

16 U. Nimmagadda, S.D. Chiravuri, M.R. Salem, et al. Preoxygenation with tidal volume and deep breathing techniques: the impact of duration of breathing and fresh gas flow Anesth Analg., 92 (2001), pp. 1337-1341

17 G. Waldemar, J.F. Schmidt, A.R. Andersen, et al. Angiotensin converting enzyme inhibition and cerebral blood flow autoregulation in normotensive and hypertensive man J Hypertens., 7 (1989), pp. 229-235

18 K.E. Britton, M. Granowska, C.C. Nimmon, et al. Cerebral blood flow in hypertensive patients with cerebrovascular disease: technique for measurement and effect of captopril Nucl Med Commun., 6 (1985), pp. 251-261

19 M. Globus, A. Keren, M. Eldad, et al. The effect of chronic propranolol therapy on regional cerebral blood flow in hypertensive patients Stroke., 14 (1983), pp. 964-967

20 T. McCalden, R. Nath Cerebrovascular autoregulation is resistant to calcium channel blockade with nimodipine Cell Mol Life Sci., 45 (1989), pp. 305-306

21 H. Cai, H. Yao, S. Ibayashi, et al. Amlodipine, a Ca2+ channel antagonist, modifies cerebral blood flow autoregulation in hypertensive rats Eur J Pharmacol., 313 (1996), pp. 103-106

22 S. Strandgaard Autoregulation of cerebral blood flow in hypertensive patients. The modifying influence of prolonged antihypertensive treatment on the tolerance to acute, drug-induced hypotension Circ Res., 53 (1976), pp. 720-727

23 D. Tryambake, J. He, M.J. Firbank, et al. Intensive blood pressure lowering increases cerebral blood flow in older subjects with hypertension Hypertension., 61 (2013), pp. 1309-1315

24 J.M. Murkin, S.J. Adams, R.J. Novick, et al. Monitoring brain oxygen saturation during coronary bypass surgery: a randomized, prospective study Anesth Analg., 104 (2007), pp. 51-58

25 J.P. Slater, T. Guarino, J. Stack, et al. Cerebral oxygen desaturation predicts cognitive decline and longer hospital stay after cardiac surgery Ann Thor Surg., 87 (2009), pp. 36-45

26 H.L. Edmonds Detection and treatment of cerebral hypoxia key to avoiding intraoperative brain injuries J Clin Monit Comput., 16 (2000), pp. 69-74

27 L.L. Beason-Held, A. Moghekar, A.B. Zonderman, et al. Longitudinal changes in cerebral blood flow in the older hypertensive brain Stroke., 38 (2007), pp. 1766-1773

28 E.M. Wesselink, T.H. Kappen, H.M. Torn, et al. Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review Br J Anaesth., 121 (2018), pp. 706-721

29 A.H. Van Beek, J.A. Claassen, M.G.O. Rikkert, et al. Cerebral autoregulation: an overview of current concepts and methodology with special focus on the elderly J Cereb Blood Flow Metab., 28 (2008), pp. 1071-1085
 

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