European journal of anaesthesiology · 2025
The role of blood pressure versus oxygen administration on cerebral oxygenation during and after anaesthesia induction: A prospective cohort study.
СтатьяНаблюдательное исследованиеСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Lam Yu K, Immink Rogier V, Schenk Jimmy, van den Dool Rokus E C, Hollmann Markus W, Veelo Denise P, Vlaar Alexander P J, Tol Johan T M, van der Ven Ward H, Terwindt Lotte E, Kho Eline
Аннотация
BACKGROUND: The effect of anaesthesia induction on cerebral perfusion is complex due to the coinciding respiratory and haemodynamic changes that occur.
OBJECTIVE: To examine how changes in blood pressure and oxygen administration are related to cerebral oxygenation and its progression over time during and after anaesthesia induction.
DESIGN: Prospective observational study.
SETTING: Dutch tertiary hospital from October 2019 to May 2022.
PATIENTS: Two hundred and fifty-one elective cardiac surgery patients of which 188 were included in the analysis.
MAIN OUTCOME MEASURES: Continuous cerebral oxygenation, measured using near-infrared spectroscopy (NIRS)-based regional cerebral tissue oximetry, was assessed in relation to mean arterial pressure (MAP), partial pressure of end-tidal oxygen (PetO 2 ) and fraction of inspired oxygen (FiO 2 ) during and after anaesthesia induction. Cerebral oxygenation between subgroups with and without the occurrence of postinduction hypotension (PIH) (defined as a MAP <65 mmHg for >60 s) was compared. PetO 2 was used as a measure for the efficacy of oxygen administration to assess the effect of a high FiO 2 of 1.0 on cerebral oxygenation.
RESULTS: Cerebral oxygenation and PetO 2 increased during anaesthesia induction with the use of a FiO 2 of 1.0, while blood pressure decreased. All parameters decreased after anaesthesia induction, but the timing of onset of decline in cerebral oxygenation coincided with the moment that the FiO 2 was adjusted from high to low, whereas it preceded the decline in MAP by 16.4 s (95% confidence interval (CI), 2.4 to 30.4; P = 0.02). The occurrence of PIH, which comprised of 42% of our study population, did not affect cerebral oxygenation. During anaesthesia induction and the use of a FiO 2 of 1.0, cerebral oxygenation increased by 0.14% (95% CI, 0.12 to 0.16; P < 0.001) per percentage point increase in PetO 2 .
CONCLUSION: Changes in regional cerebral tissue oximetry during and after anaesthesia induction are more related to changes in oxygen administration than blood pressure.
TRIAL REGISTRATION: Overview of medical research in the Netherlands (reference: NL-OMON29121).
OBJECTIVE: To examine how changes in blood pressure and oxygen administration are related to cerebral oxygenation and its progression over time during and after anaesthesia induction.
DESIGN: Prospective observational study.
SETTING: Dutch tertiary hospital from October 2019 to May 2022.
PATIENTS: Two hundred and fifty-one elective cardiac surgery patients of which 188 were included in the analysis.
MAIN OUTCOME MEASURES: Continuous cerebral oxygenation, measured using near-infrared spectroscopy (NIRS)-based regional cerebral tissue oximetry, was assessed in relation to mean arterial pressure (MAP), partial pressure of end-tidal oxygen (PetO 2 ) and fraction of inspired oxygen (FiO 2 ) during and after anaesthesia induction. Cerebral oxygenation between subgroups with and without the occurrence of postinduction hypotension (PIH) (defined as a MAP <65 mmHg for >60 s) was compared. PetO 2 was used as a measure for the efficacy of oxygen administration to assess the effect of a high FiO 2 of 1.0 on cerebral oxygenation.
RESULTS: Cerebral oxygenation and PetO 2 increased during anaesthesia induction with the use of a FiO 2 of 1.0, while blood pressure decreased. All parameters decreased after anaesthesia induction, but the timing of onset of decline in cerebral oxygenation coincided with the moment that the FiO 2 was adjusted from high to low, whereas it preceded the decline in MAP by 16.4 s (95% confidence interval (CI), 2.4 to 30.4; P = 0.02). The occurrence of PIH, which comprised of 42% of our study population, did not affect cerebral oxygenation. During anaesthesia induction and the use of a FiO 2 of 1.0, cerebral oxygenation increased by 0.14% (95% CI, 0.12 to 0.16; P < 0.001) per percentage point increase in PetO 2 .
CONCLUSION: Changes in regional cerebral tissue oximetry during and after anaesthesia induction are more related to changes in oxygen administration than blood pressure.
TRIAL REGISTRATION: Overview of medical research in the Netherlands (reference: NL-OMON29121).