Research
Print page Print page
Switch language
Rigshospitalet - a part of Copenhagen University Hospital
Published

Internal carotid artery blood flow is enhanced by elevating blood pressure during combined propofol-remifentanil and thoracic epidural anaesthesia: A randomised cross-over trial

Research output: Contribution to journalJournal articleResearchpeer-review

  1. Apolipoprotein E ε4 and cognitive function after surgery in middle-aged and elderly Danish twins

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Noninvasive respiratory support in the hypoxaemic peri-operative/periprocedural patient: A joint ESA/ESICM guideline

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Reply to: will one hour less make any difference?

    Research output: Contribution to journalLetterpeer-review

  4. Functional recovery after knee arthroplasty with regional analgesia

    Research output: Contribution to journalLetterpeer-review

  1. Distribution of concurrent training sessions does not impact endurance adaptation

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. A Standard Set of Value-Based Patient-Centered Outcomes for Pancreatic Carcinoma: An International Delphi Survey

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Glycemic Control and Variability of Diabetes Secondary to Total Pancreatectomy Assessed by Continuous Glucose Monitoring

    Research output: Contribution to journalJournal articleResearchpeer-review

View graph of relations

BACKGROUND: Anaesthesia reduces mean arterial pressure (MAP), and to preserve organ perfusion, vasopressors are often used to maintain MAP above 60 mmHg. Cognitive dysfunction is common following major surgery and may relate to intra-operative cerebral hypoperfusion.

OBJECTIVE: The aim of this study was to evaluate whether internal carotid artery (ICA) blood flow increases when MAP is kept higher than 60 mmHg using noradrenaline.

DESIGN: A randomised, cross-over trial.

SETTING: Department of Anaesthesia, Rigshospitalet, Copenhagen, Denmark, from December 2017 to April 2018.

PATIENTS: Patients with median [IQR] age 71 [63 to 75] years underwent pancreaticoduodenectomy (n = 19), total pancreatic resection (n = 1) or gastro-entero anastomosis (n = 2) during combined propofol-remifentanil and thoracic epidural anaesthesia.

INTERVENTION: MAP was maintained between 60 to 65, 70 to 75 and 80 to 85 mmHg, in a random order, by noradrenaline infusion at a stable level of anaesthesia.

MAIN OUTCOME MEASURES: Primary outcome was change in ICA flow at MAP 60 to 65 vs. 80 to 85 mmHg. Secondary outcomes were change in ICA flow at MAP 60 to 65 vs. 70 to 75 and 70 to 75 vs. 80 to 85 mmHg. Duplex ultrasound evaluated ICA flow.

RESULTS: A (mean ± SD) increase in MAP from 62 ± 1 to 82 ± 1 mmHg elevated ICA flow from 196 ± 53 to 226 ± 61 ml min (mean difference 31 ml min; 95% CI 19 to 42; P < 0.0001). An increase in MAP from 62 ± 1 to 72 ± 1 mmHg elevated ICA flow to 210 ± 52 ml min (P = 0.0271) and ICA flow increased further (P = 0.0165) when MAP was elevated to 82 ± 1 mmHg.

CONCLUSION: During combined propofol-remifentanil and thoracic epidural anaesthesia, ICA flow increased by approximately 15% when the MAP was elevated from about 60 to 80 mmHg. Treatment of a reduction in MAP brought about by anaesthesia seems to enhance ICA flow.

TRIAL REGISTRATION: Clinicaltrials.gov ID: NCT03309917.

Original languageEnglish
JournalEuropean Journal of Anaesthesiology
Volume37
Issue number6
Pages (from-to)482-490
Number of pages9
ISSN0265-0215
DOIs
Publication statusPublished - Jun 2020

ID: 62408380