Top

Journal of Clinical Monitoring and Computing

Published in:

04-12-2022 | Ultrasound | Original Research

Relationships between common carotid artery blood flow and anesthesia, pneumoperitoneum, and head-down tilt position: a linear mixed-effect analysis

Authors: Hyun-Kyu Yoon, Hansu Bae, Seokha Yoo, Young-Won Kim, Jinyoung Bae, Sun-Kyung Park, Hansol Kim, Young-Jin Lim, Jin-Tae Kim

Published in: Journal of Clinical Monitoring and Computing | Issue 2/2023

Abstract

This study investigated the effects of pneumoperitoneum and the head-down tilt position on common carotid artery (CCA) blood flow in surgical patients. Methods: This prospective observational study included 20 patients who underwent gynecological surgery. CCA blood flow was measured using Doppler ultrasound at four-time points: awake in the supine position [T1], 3 min after anesthesia induction in the supine position [T2], 3 min after pneumoperitoneum in the supine position [T3], and 3 min after pneumoperitoneum in the head-down tilt position [T4]. Hemodynamic and respiratory parameters were also recorded at each time point. Linear mixed-effect analyses were performed to compare CCA blood flow across the time points and assess its relationship with hemodynamic parameters. Results: Compared with T1, CCA blood flow decreased significantly at T2 (345.4 [288.0–392.9] vs. 293.1 [253.0–342.6], P = 0.048). CCA blood flow were also significantly lower at T3 and T4 compared with T1 (345.4 [288.0–392.9] vs. 283.6 [258.8–307.6] and 287.1 [242.1–321.4], P = 0.005 and 0.016, respectively). CCA blood flow at T3 and T4 did not significantly differ from that at T2. Changes in CCA blood flow were significantly associated with changes in cardiac index and stroke volume index (P = 0.011 and 0.024, respectively). Conclusion: CCA blood flow was significantly decreased by anesthesia induction. Inducing pneumoperitoneum, with or without the head-down tilt position, did not further decrease CCA blood flow if the cardiac index remained unchanged. The cardiac index and stroke volume index were significantly associated with CCA blood flow.

Clinical trial registration: Clinicaltrials.gov (NCT04233177, January 18, 2020).

Buia A, Stockhausen F, Hanisch E. Laparoscopic surgery: a qualified systematic review. World J Methodol. 2015;5:238–54. https://doi.org/10.5662/wjm.v5.i4.238.CrossRefPubMedPubMedCentral

Group TCcLoORS. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6:477–84. https://doi.org/10.1016/S1470-2045(05)70221-7.CrossRef

Kalmar AF, Foubert L, Hendrickx JFA, Mottrie A, Absalom A, Mortier EP, Struys MMRF. Influence of steep Trendelenburg position and CO 2 pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy. Br J Anaesth. 2010;104:433–9. https://doi.org/10.1093/bja/aeq018.CrossRefPubMed

Willie CK, Tzeng YC, Fisher JA, Ainslie PN. Integrative regulation of human brain blood flow. J Physiol. 2014;592:841–59. https://doi.org/10.1113/jphysiol.2013.268953.CrossRefPubMedPubMedCentral

Van Beek AH, Claassen JA, Rikkert MGO, Jansen RW. Cerebral autoregulation: an overview of current concepts and methodology with special focus on the elderly. J Cereb Blood Flow Metab. 2008;28:1071–85. https://doi.org/10.1038/jcbfm.2008.13.CrossRefPubMed

Lassen NA. Cerebral blood flow and oxygen consumption in man. Physiol Rev. 1959;39:183–238. https://doi.org/10.1152/physrev.1959.39.2.183.CrossRefPubMed

Claassen JA, Thijssen DH, Panerai RB, Faraci FM. Regulation of cerebral blood flow in humans: physiology and clinical implications of autoregulation. Physiol Rev. 2021;101:1487–559. https://doi.org/10.1152/physrev.00022.2020.CrossRefPubMedPubMedCentral

Paulson O, Strandgaard S, Edvinsson L. Cerebral autoregulation. Cerebrovasc Brain Metab Rev. 1990;2:161–92.PubMed

Tan CO. Defining the characteristic relationship between arterial pressure and cerebral flow. J Appl Physiol. 2012;113:1194–200. https://doi.org/10.1152/japplphysiol.00783.2012.CrossRefPubMedPubMedCentral

10.

Rappold T, Laflam A, Hori D, Brown C, Brandt J, Mintz CD, Sieber F, Gottschalk A, Yenokyan G, Everett A, Hogue CW. Evidence of an association between brain cellular injury and cognitive decline after non-cardiac surgery. Br J Anaesth. 2016;116:83–9. https://doi.org/10.1093/bja/aev415.CrossRefPubMed

11.

Ono M, Arnaoutakis GJ, Fine DM, Brady K, Easley RB, Zheng Y, Brown C, Katz NM, Grams ME, Hogue CW. Blood pressure excursions below the cerebral autoregulation threshold during cardiac surgery are associated with acute kidney injury*. Crit Care Med. 2013;41:464–71. https://doi.org/10.1097/ccm.0b013e31826ab3a1.CrossRefPubMedPubMedCentral

12.

Ono M, Brady K, Easley RB, Brown C, Kraut M, Gottesman RF, Hogue CW. Duration and magnitude of blood pressure below cerebral autoregulation threshold during cardiopulmonary bypass is associated with major morbidity and operative mortality. J Thorac Cardiovasc Surg. 2014;147:483–9. https://doi.org/10.1016/j.jtcvs.2013.07.069.CrossRefPubMed

13.

Soustiel JF, Levy E, Zaaroor M, Bibi R, Lukaschuk S, Manor D. A new angle-independent doppler ultrasonic device for assessment of blood flow volume in the extracranial internal carotid artery. J Ultrasound Med. 2002;21:1405–12. https://doi.org/10.7863/jum.2002.21.12.1405.CrossRefPubMed

14.

Skytioti M, Elstad M, Sovik S. Internal carotid artery blood flow response to anesthesia, pneumoperitoneum, and head-up tilt during laparoscopic cholecystectomy. Anesthesiology. 2019;131:512–20. https://doi.org/10.1097/ALN.0000000000002838.CrossRefPubMed

15.

Yu J, Park JY, Hong JH, Hwang JH, Kim YK. Effect of pneumoperitoneum and Trendelenburg position on internal carotid artery blood flow measured by ultrasound during robotic prostatectomy. Clin Physiol Funct Imaging. 2022;42:139–45. https://doi.org/10.1111/cpf.12742.CrossRefPubMed

16.

Schlünzen L, Juul N, Hansen KV, Cold GE. Regional cerebral blood flow and glucose metabolism during propofol anaesthesia in healthy subjects studied with positron emission tomography. Acta Anaesthesiol Scand. 2012;56:248–55. https://doi.org/10.1111/j.1399-6576.2011.02561.x.CrossRefPubMed

17.

Lestar M, Gunnarsson L, Lagerstrand L, Wiklund P, Odeberg-Wernerman S. Hemodynamic perturbations during robot-assisted laparoscopic radical prostatectomy in 45° trendelenburg position. Anesth Analg. 2011;113:1069–75. https://doi.org/10.1213/ane.0b013e3182075d1f.CrossRefPubMed

18.

Tan PL, Lee TL, Tweed WA. Carbon dioxide absorption and gas exchange during pelvic laparoscopy. Can J Anaesth. 1992;39:677–81. https://doi.org/10.1007/bf03008229.CrossRefPubMed

19.

Kamine TH, Papavassiliou E, Schneider BE. Effect of abdominal insufflation for laparoscopy on intracranial pressure. JAMA Surg. 2014;149:380–2. https://doi.org/10.1001/jamasurg.2013.3024.CrossRefPubMed

20.

Mavrocordatos P, Bissonnette B, Ravussin P. Effects of neck position and head elevation on intracranial pressure in anaesthetized neurosurgical patients: preliminary results. J Neurosurg Anesthesiol. 2000;12:10–4. https://doi.org/10.1097/00008506-200001000-00003.CrossRefPubMed

21.

Tanaka N, Yamamoto M, Abe T, Osawa T, Matsumoto R, Shinohara N, Saito H, Uchida Y, Morimoto Y. Changes of cerebral blood volume during robot-assisted laparoscopic radical prostatectomy: observational prospective study using near-infrared time-resolved spectroscopy. J Endourol. 2019;33:995–1001. https://doi.org/10.1089/end.2019.0217.CrossRefPubMed

22.

Chen K, Wang L, Wang Q, Liu X, Lu Y, Li Y, Wong GTC. Effects of pneumoperitoneum and steep Trendelenburg position on cerebral hemodynamics during robotic-assisted laparoscopic radical prostatectomy: a randomized controlled study. Medicine. 2019;98:e15794. https://doi.org/10.1097/MD.0000000000015794.CrossRefPubMedPubMedCentral

23.

Robba C, Cardim D, Donnelly J, Bertuccio A, Bacigaluppi S, Bragazzi N, Cabella B, Liu X, Matta B, Lattuada M, Czosnyka M. Effects of pneumoperitoneum and Trendelenburg position on intracranial pressure assessed using different non-invasive methods. Br J Anaesth. 2016;117:783–91. https://doi.org/10.1093/bja/aew356.CrossRefPubMed

24.

Beck S, Ragab H, Hoop D, Meßner-Schmitt A, Rademacher C, Kahl U, Von Breunig F, Haese A, Graefen M, Zöllner C, Fischer M. Comparing the effect of positioning on cerebral autoregulation during radical prostatectomy: a prospective observational study. J Clin Monit Comput. 2021;35:891–901. https://doi.org/10.1007/s10877-020-00549-0.CrossRefPubMed

25.

Matsuoka T, Ishiyama T, Shintani N, Kotoda M, Mitsui K, Matsukawa T. Changes of cerebral regional oxygen saturation during pneumoperitoneum and Trendelenburg position under propofol anesthesia: a prospective observational study. BMC Anesthesiol. 2019;19:72. https://doi.org/10.1186/s12871-019-0736-4.CrossRefPubMedPubMedCentral

26.

Wiesinger C, Schoeb DS, Stockhammer M, Mirtezani E, Mitterschiffthaler L, Wagner H, Knotzer J, Pauer W. Cerebral oxygenation in 45-degree trendelenburg position for robot-assisted radical prostatectomy: a single-center, open, controlled pilot study. BMC Urol. 2020;20:198. https://doi.org/10.1186/s12894-020-00774-4.CrossRefPubMedPubMedCentral

27.

Matanes E, Weissman A, Rivlin A, Lauterbach R, Amit A, Wiener Z, Lowenstein L. Effects of pneumoperitoneum and the steep Trendelenburg position on heart rate variability and cerebral oxygenation during robotic sacrocolpopexy. J Minim Invasive Gynecol. 2018;25:70–5. https://doi.org/10.1016/j.jmig.2017.07.009.CrossRefPubMed

28.

Schramm P, Treiber AH, Berres M, Pestel G, Engelhard K, Werner C, Closhen D. Time course of cerebrovascular autoregulation during extreme Trendelenburg position for robotic-assisted prostatic surgery. Anaesthesia. 2014;69:58–63. https://doi.org/10.1111/anae.12477.CrossRefPubMed

29.

Skytioti M, Sovik S, Elstad M. Internal carotid artery blood flow in healthy awake subjects is reduced by simulated hypovolemia and noninvasive mechanical ventilation. Physiol Rep. 2016;4:e12969. https://doi.org/10.14814/phy2.12969.CrossRefPubMedPubMedCentral

30.

Meng L, Hou W, Chui J, Han R, Gelb AW. Cardiac output and cerebral blood flow. Anesthesiology. 2015;123:1198–208. https://doi.org/10.1097/aln.0000000000000872.CrossRefPubMed

31.

Van Houte J, Mooi FJ, Montenij LJ, Meijs LPB, Suriani I, Conjaerts BCM, Houterman S, Bouwman AR. Correlation of carotid doppler blood flow with invasive cardiac output measurements in cardiac surgery patients. J Cardiothorac Vasc Anesth. 2021;36:1081–91. https://doi.org/10.1053/j.jvca.2021 09.043.CrossRefPubMed

32.

Jin D, Yu H, Li H, Zhao N, Zhang Y, Li J, Cui J, Tang D, Li Y, Teng Y, Zeng P. Hemodynamic changes of anesthesia, pneumoperitoneum, and head-down tilt during laparoscopic surgery in elderly patients. Ann Transl Med. 2021;9:1177. https://doi.org/10.21037/atm-21-3407.CrossRefPubMedPubMedCentral

33.

Johnny. Carbon dioxide and the cerebral circulation. Anesthesiology. 1998;88:1365–86. https://doi.org/10.1097/00000542-199805000-00029.CrossRef

34.

O’leary E, Hubbard K, Tormey W, Cunningham A. Laparoscopic cholecystectomy: haemodynamic and neuroendocrine responses after pneumoperitoneum and changes in position. Br J Anaesth. 1996;76:640–4. https://doi.org/10.1093/bja/76.5.640.CrossRefPubMed

35.

Marshall-Goebel K, Ambarki K, Eklund A, Malm J, Mulder E, Gerlach D, Bershad E, Rittweger J. Effects of short-term exposure to head-down tilt on cerebral hemodynamics: a prospective evaluation of a spaceflight analog using phase-contrast MRI. J Appl Physiol. 2016;120:1466–73. https://doi.org/10.1152/japplphysiol.00841.2015.CrossRefPubMedPubMedCentral

36.

Friedman JA, Anderson RE, Meyer FB. Techniques of intraoperative cerebral blood flow measurement. Neurosurg Focus. 2000;9:1–5. https://doi.org/10.3171/foc.2000.9.5.4.CrossRef

37.

Khan MA, Liu J, Tarumi T, Lawley JS, Liu P, Zhu DC, Lu H, Zhang R. Measurement of cerebral blood flow using phase contrast magnetic resonance imaging and duplex ultrasonography. J Cereb Blood Flow Metab. 2017;37:541–9. https://doi.org/10.1177/0271678x16631149.CrossRefPubMed

38.

Krueger C, Tian L. A comparison of the general linear mixed model and repeated measures ANOVA using a dataset with multiple missing data points. Biol Res Nurs. 2004;6:151–7. https://doi.org/10.1177/1099800404267682.CrossRefPubMed

39.

Schober P, Vetter TR. Repeated measures designs and analysis of longitudinal data: if at first you do not succeed-try, try again. Anesth Analg. 2018;127:569–75. https://doi.org/10.1213/ANE.0000000000003511.CrossRefPubMedPubMedCentral

Title: Relationships between common carotid artery blood flow and anesthesia, pneumoperitoneum, and head-down tilt position: a linear mixed-effect analysis
Authors: Hyun-Kyu Yoon
Hansu Bae
Seokha Yoo
Young-Won Kim
Jinyoung Bae
Sun-Kyung Park
Hansol Kim
Young-Jin Lim
Jin-Tae Kim
Publication date: 04-12-2022
Publisher: Springer Netherlands
Keywords: Ultrasound
Ultrasound
Published in: Journal of Clinical Monitoring and Computing / Issue 2/2023
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI: https://doi.org/10.1007/s10877-022-00940-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Relationships between common carotid artery blood flow and anesthesia, pneumoperitoneum, and head-down tilt position: a linear mixed-effect analysis

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2023

Reliability of stroke volume or pulse pressure variation as dynamic predictors of fluid responsiveness in laparoscopic surgery: a systematic review

Quantitative regional cerebral blood flow measurement using near-infrared spectroscopy and indocyanine green in patients undergoing superficial temporal to middle cerebral artery bypass for moyamoya disease: a novel method using a frequency filter

Ultrasound-guided cerebral resuscitation in patients with severe traumatic brain Injury

A semi-automated device rapidly determine circulating blood volume in healthy males and carbon monoxide uptake kinetics of arterial and venous blood

“Original Research” instead research Neural networks for estimation of facial palsy after vestibular schwannoma surgery

Indicators of haemodynamic instability and left ventricular function in a porcine model of esmolol induced negative inotropy