Skip to main content Accessibility help
×
Hostname: page-component-68c7f8b79f-lqrcg Total loading time: 0 Render date: 2026-01-02T02:27:38.491Z Has data issue: false hasContentIssue false

12 - Effects on Brain Function

from Section 2 - Targeting Effects

Published online by Cambridge University Press:  03 December 2019

By
Neus Fabregas  and
Adrian W. Gelb
Edited by
Pedro L. Gambús  and
Jan F. A. Hendrickx
Pedro L. Gambús
Affiliation:
Hospital Clinic de Barcelona, Spain
Jan F. A. Hendrickx
Affiliation:
Aalst General Hospital, Belgium
Get access

Summary

Surgery and anaesthesia alter the function of the brain and its control mechanisms. In the operating room, we daily observe the effects of anaesthetic agents during induction and recovery from anaesthesia: changes in the electroencephalogram, on consciousness, muscle tone as well as in the responses to different stimulations that immediately disappear after induction, and reappear gradually when anaesthetic effects wear off. To prevent short- or long-term functional changes of the brain, the parameters of its physiological defence mechanisms must be maintained within the patient’s normal range. Failing to do so might lead to complications that can significantly alter patient outcome.

Information

Type
Chapter
Information
Personalized Anaesthesia
Targeting Physiological Systems for Optimal Effect
 , pp. 175 - 196
Publisher: Cambridge University Press
Print publication year: 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Piechnik, SK, Yang, X, Czosnyka, M, Smielewski, P, Fletcher, SH, Jones, AL, Pickard, JD: The continuous assessment of cerebrovascular reactivity: a validation of the method in healthy volunteers. Anesth.Analg. 1999; 89: 944–9.Google Scholar
McCulloch, TJ, Visco, E, Lam, AM: Graded hypercapnia and cerebral autoregulation during sevoflurane or propofol anesthesia. Anesthesiology. 2000; 93: 1205–8.CrossRefGoogle ScholarPubMed
Sharma, D, Bithal, PK, Dash, HH, Chouhan, RS, Sookplung, P, Valivala, MS: Cerebral autoregulation and CO2 reactivity before and after supratentorial tumor resection. J.Neurosurg.Anesthesiol. 2010; 22: 132–7.Google Scholar
Joshi, B, Brady, K, Lee, J, Easly, B, Panigrahi, R, Smielewski, P, Czosnyka, MM, Hogue, CW: Impaired autoregulation of cerebral blood flow during rewarming from hypothermic cardiopulmonary bypass and its potential association with stroke. Anesth.Analg. 2010; 110 : 321–8.Google Scholar
Klein, KU, Fukui, K, Schramm, P, Stadie, A, Fischer, G, Werner, C, Oertel, J, Engelhard, K: Human cerebral microcirculation and oxygen saturation during propofol-induced reduction of bispectral index. Br.J.Anaesth. 2011; 107 (5): 735–41.Google Scholar
Burkhart, CS, Rossi, A, Dell-Kuster, S, Gamberini, M, Möckli, A, Siegemund, M, Czosnyka, M, Strebel, SP, Steiner, LA: Effect of age on intraoperative cerebrovascular autoregulation and near-infrared spectroscopy-derived cerebral oxygenation. Br.J.Anaesth. 2011; 107 (5): 742–8.CrossRefGoogle ScholarPubMed
Joshi, B, Ono, M, Brown, C, Brady, K,Easley, RB, Yenokyan, G, Gottesman, RF, Hogue, CW: Predicting the limits of cerebral autoregulation during cardiopulmonary bypass. Anesth.Analg. 2012; 114: 503–10.CrossRefGoogle ScholarPubMed
Meng, L, Gelb, AW, Alexander, BS, Cerussi, AE, Tromberg, BJ, Yu, Z, Mantulin, MM: Impact of phenylephrine administration on cerebral tissue oxygen saturation and blood volume is modulated by carbon dioxide in anaesthetized patients. Br.J.Anaesth. 2012; 108 (5): 815–22.CrossRefGoogle ScholarPubMed
Jeong, H, Jeong, S, Lim, HJ, Lee, J, Yoo, KY: Cerebral oxygen saturation measured by near-infrared spectroscopy and jugular venous bulb oxygen saturation during arthroscopic shoulder surgery in beach chair position under sevoflurane-nitrous oxide or propofol-remifentanil anesthesia. Anesthesiology. 2012; 116: 1047–56.CrossRefGoogle ScholarPubMed
Meng, L, Mantulin, WW, Cerussi, AE, Tromberg, BJ, Yu, Z, Laning, K, Kain, ZN, Cannesson, M, Gelb, AW: Head-up tilt and hyperventilation produce similar changes in cerebral oxygenation and blood volume: an observational comparison study using frequency-domain near-infrared spectroscopy. Can.J.Anaesth. 2012; 59 (4): 357–65.Google Scholar
Meng, L, Gelb, AW, McDonagh, DL: Changes in cerebral tissue oxygen saturation during anesthetic-induced hypotension: an interpretation based on neurovascular coupling and cerebral autoregulation. Anaesthesia. 2013; 68: 736–41.CrossRefGoogle Scholar
Alexander, BS, Gelb, AW, Mantulin, WW, Cerussi, AE, Tromberg, BJ, Yu, Z, Lee, C, Meng, L: Impact of stepwise hyperventilation on cerebral tissue oxygen saturation in anesthetized patients: a mechanistic study. Acta.Anaesthesiol.Scand. 2013; 57 (5): 604–12.CrossRefGoogle ScholarPubMed
Murphy, GS, Szokol, JW, Avram, MJ, Greenberg, SB, Shear, TD, Vender, JS, Levin, SD, Koh, JL, Parikh, KN, Patel, SS: Effect of ventilation on cerebral oxygenation in patients undergoing surgery in the beach chair position: a randomized controlled trial. Br.J.Anaesth. 2014; 113 (4): 618–27.CrossRefGoogle ScholarPubMed
Tzeng, YC, MacRae, BA, Ainslie, PN,Chan, GSH. Fundamental relationships between blood pressure and cerebral blood flow in humans. J.Appl.Physiol. 2014; 117: 1037–48.CrossRefGoogle ScholarPubMed
Ono, M, Brady, K, Easley, RB Brown, C, Kraut, M, Gottesman, RF, Hogue, C: 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.CrossRefGoogle ScholarPubMed
Moerman, AT, Vanbiervliet, VM, Van Wesenmael, A, Bouchez, SM, Wouters, PF, De Hert, SG: Assessment of cerebral autoregulation patterns with near-infrared spectroscopy during pharmacological-induced pressure changes. Anesthesiology. 2015; 123: 327–35.CrossRefGoogle ScholarPubMed
Laflam, A, Joshi, B, Brady, K, Yenokyan, G, Brown, C, Everett, A, Selnes, O, McFarland, E, Hogue, CW: Shoulder surgery in the beach chair position is associated with diminished cerebral autoregulation but no differences in postoperative cognition or brain injury biomarker levels compared with supine positioning: the anesthesia patient safety foundation beach chair study. Anesth.Analg. 2015; 120: 176–85.CrossRefGoogle ScholarPubMed
Picton, P, Dering, A, Alexander, A, Neff, M, Miller, BS, Shanks, A, Housey, M, Mashour, GA: Influence of ventilation strategies and anesthetic techniques on regional cerebral oximetry in the beach chair position. A prospective interventional study with a randomized comparison of two anesthetics. Anesthesiology. 2015; 123: 765–74.Google ScholarPubMed
Deschamps, A, Hall, R, Grocott, H, Mazer, D, Choi, PT, Turgeon, AF, de Medicis, E, Bussières, JS, Hudson, C, Syed, S, Seal, D, Herd, S, Lambert, J, Denault, A: For the Canadian Perioperative Anesthesia Clinical Trials Group: Cerebral oximetry monitoring to maintain normal cerebral oxygen saturation during high-risk cardiac surgery. A randomized controlled feasibility trial. Anesthesiology. 2016; 124: 826–36.CrossRefGoogle Scholar
Goettel, N, Patet, C, Rossi, A, Burkhart, CS, Czosnyka, M, Strebel, SP, Steiner, LA: Monitoring of cerebral blood flow autoregulation in adults undergoing sevoflurane anesthesia: a prospective cohort study of two aged groups. J.Clin.Monitor.Comput. 2016; 30: 255–64.CrossRefGoogle Scholar
Fantini, S, Franceschini-Fantini, MA, Maier, JS, Walker, SA, Barbieri, B, Gratton, E: Frequency-domain multichannel optical detector for non-invasive tissue spectroscopy and oximetry. Opt.Engineer. 1995; 34: 231–6.Google Scholar
Davie, SN, Grocott, HP: Impact of extracranial contamination on regional cerebral oxygen saturation: a comparison of three cerebral oximetry technologies. Anesthesiology. 2012; 116: 834–40.CrossRefGoogle ScholarPubMed
Brady, KM, Lee, JK, Kliber, KK, Easley, RB, Koehler, RC, Shaffner, DH: Continuous time domain analysis of cerebrovascular autoregulation using near infrared spectroscopy. Stroke. 2007; 38: 2818–25.CrossRefGoogle ScholarPubMed
Steiner, LA, Pfister, D, Strebel, SP, Radolovich, D, Smielewski, P, Czosnyka, M: Near-infrared spectroscopy can monitor dynamic cerebral autoregulation in adults. Neurocrit.Care. 2009; 10: 122–8.CrossRefGoogle ScholarPubMed
Aaslid, R, Lindegaard, KF, Sorteberg, W, Nornes, H: Cerebral autoregulation dynamics in humans. Stroke. 1989; 20: 45–52.Google Scholar
Mariappan, R, Mehta, J, Chui, J, Manninen, P, Venkatraghavan, L: Cerebrovascular reactivity to carbon dioxide under anaesthesia: a qualitative systematic review. J.Neurosurg.Anesthesiol. 2015; 27: 123–35.CrossRefGoogle ScholarPubMed
Strebel, A, Lam, A, Matta, B, Mayberg, TS, Aaslid, R, Newell DW: Dynamic and static cerebral autoregulation during isoflurane, desflurane and propofol anesthesia. Anesthesiology. 1995; 83: 66–76.Google Scholar
Smielewski, P, Czosnyka, M, Steiner, L, Belestri, M, Piechnik, S, Pickard, JD: ICM+: software for on-line analysis of bedside monitoring data after severe head trauma. Acta.Neurochir.Suppl. 2005; 95: 43–9.CrossRefGoogle ScholarPubMed
Czosnyka, M, Smielewski, P, Kirkpatrick, P, Menon, DK, Pickard, JD: Monitoring of cerebral autoregulation in head-injured patients. Stroke. 1996; 27: 1829–34.CrossRefGoogle ScholarPubMed
YCh, Tzeng, Ainsle, PN: Blood pressure regulation IX: cerebral autoregulation under blood pressure challenges. Eur.J.Appl.Physiol. 2014; 114: 545–59.Google Scholar
Hancock, SM, Mahajan, RP, Athanassiou, LA: Noninvasive estimation of cerebral perfusion pressure and zero flow pressure in healthy volunteers: the effects of changes in end-tidal carbon dioxide. Anesth.Analg. 2003; 96: 847–51.Google ScholarPubMed
Aaslid, R, Lash, SR, Bardy, GH, Gild, WH, Newell DW: Dynamic pressure–flow velocity relationships in the human cerebral circulation. Stroke. 2003; 34: 1645–9.Google Scholar
Meng, L, Gelb, AW: Regulation of cerebral autoregulation by carbon dioxide. Anesthesiology. 2015; 122: 196–205.CrossRefGoogle Scholar
Lassen, NA: Cerebral blood flow and oxygen consumption in man. Physiol.Rev. 1959; 39: 183–238.Google Scholar
Larsen, FS, Olsen, KS, Hansen, BA, Paulson, OB, Knudsen, GM: Transcranial Doppler is valid for determination of the lower limit of cerebral blood flow autoregulation. Stroke. 1994; 25: 1985–8.CrossRefGoogle ScholarPubMed
Fitch, W, Ferguson, GG, Sengupta, D, Garibi, J, Harper, AM: Autoregulation of cerebral blood flow during controlled hypotension in baboons. J.Neurol.Neurosurg.Psychiatry. 1976; 39: 1014–22.CrossRefGoogle ScholarPubMed
Meng, L, Hou, W, Chui, J, Han, R, Gelb, AW: Cardiac output and cerebral blood flow. The integrated regulation of brain perfusion in adult humans. Anesthesiology. 2015; 123: 1198–208.Google Scholar
Brady, KM, Easley, RB, Kibler, K, Kaczka, DW, Andropoulos, D, Fraser, CD 3rd, Smielewski, P, Czosnyka, M, Adams, GJ, Rhee, CJ, Rusin, CG: Positive end-expiratory pressure oscillation facilitates brain vascular reactivity monitoring. J.Appl.Physiol. 2012; 113: 1362–8.Google Scholar
Tan, CO: Defining the characteristic relationship between arterial pressure and cerebral flow. J.Appl.Physiol. 2012; 113: 1194–200.CrossRefGoogle ScholarPubMed
Jones, SC, Radinsky, CR, Furlan, AJ, Chyatte, D, Qu, Y, Easley, KA, Perez-Trepichio, AD: Variability in the magnitude of the cerebral blood flow response and the shape of the cerebral blood flow-pressure autoregulation curve during hypotension in normal rats. Anesthesiology. 2002; 97: 488–96.Google Scholar
Deegan, BM, Devine, ER, Geraghty, MC, Jones, E, Ólaighin, G, Serrador, JM: The relationship between cardiac output and dynamic cerebral autoregulation in humans. J.Appl.Phsyiol. 2010; 109: 1424–31.Google Scholar
Tiecks, FP, Lam, M, Aaslid, R, Newell, DW: Comparison of static and dynamic cerebral autoregulation measurements. Stroke. 1995; 26 (6): 1014–19.CrossRefGoogle ScholarPubMed
Harper, M, Glass, HI: Effect of alterations in the carbon dioxide tension on the blood flow through the cerebral cortex at normal and low blood pressures. J.Neurol.Neurosurg.Psychiatry. 1965; 28: 449–52.CrossRefGoogle Scholar
Ito, H, Ibaraki, M, Kanno, I, Fukuda, H, Miura, S: Changes in the arterial fraction of human cerebral blood volume during hypercapnia and hypocapnia measured by positron emission tomography. J.Cereb.Blood.Flow.Metab. 2005; 25: 852–7.CrossRefGoogle ScholarPubMed
Ito, H, Kanno, IK, Ibaraki, M, Hatazawa, J, Miura, S: Changes in human cerebral blood flow and cerebral blood volume during hypercapnia and hypocapnia measured by positron emission tomography. J.Cereb.Blood.Flow.Metab. 2003; 23: 665–70.Google Scholar
Low, DA, Wingo, JE, Keller, DM, Davis, SL, Zhang, R, Crandall, CG: Cerebrovascular responsiveness to steady-state changes in end-tidal CO2 during passive heat stress. J.Appl.Physiol. 2008; 104: 976–81.Google Scholar
Kadoy, Y, Himohara, H, Kunimoto, F, Saito, S, Ide, M, Hiraoka, H, Kawahara, F, Goto, F: Diabetic patients have an impaired cerebral vasodilatory response to hypercapnia under propofol anaesthesia. Stroke. 2003; 34: 2399–403.Google Scholar
Vogels, RL, Scheltens, P, Schroeder-Tanka, JM, Weinstein, HC: Cognitive impairment in heart failure: a systematic review of the literature. Eur.J.Heart.Fail. 2007; 9: 440–9.Google Scholar
Smith, JJ, Porth, CM, Erickson, M: Hemodynamic response to the upright posture. J.Clin.Pharmacol. 1994; 34: 375–86.CrossRefGoogle Scholar
Fraser, KS, Heckman, GA, McKelvie, RS, Harkness, K, Middleton, LE, Hughson, RL: Cerebral hypoperfusion is exaggerated with an upright posture in heart failure: impact of depressed cardiac output. JACC Heart Fail. 2015; 3: 168–75.Google Scholar
Cullen, DJ, Kirby, RR: Beach chair position may decrease cerebral perfusion: catastrophic outcomes have occurred. APSF Newsletter. 2007; 22 (2): 25–7.Google Scholar
Lee, L, Caplan, R: APSF Workshop: Cerebral perfusion experts share views on management of head-up cases. Anesthesia Patient Safety Foundation Newsletter. 2010; 24: 45–8.Google Scholar
Bijker, JB, Gelb, AW: The role of hypotension in perioperative stroke. Can.J.Anesth. 2013; 60: 159–67.CrossRefGoogle ScholarPubMed
Lam, A, Matta, B, Mayberg, T, Strebel, S: Changes in cerebral blood flow velocity with onset of EEG silence during inhalational anesthesia in humans. Evidence of flow metabolism coupling. J.Cereb.Blood.Flow.Metab. 1994; 15: 714–17.Google Scholar
Attwell, D, Buchasn, AM, Charpak, A, Macvicar, BA, Newman, EA: Glial and neuronal control of brain blood flow. Nature. 2010; 468: 232–43.Google Scholar
Oshima, T, Karasawa, F, Sato, T: Effects of propofol on cerebral blood flow and the metabolic rate of oxygen in humans. Acta.Anaesth.Scand. 2002; 46: 232–43.CrossRefGoogle ScholarPubMed
Steiner, LA, Johnston, AJ, Chatfield, DA, Czosnyka, M, Coleman, MR, Coles, JP, Gupta, AK, Pickard, JD, Menon, DK: The effects of large-dose propofol on cerebrovascular pressure autoregulation in head-injured patients. Anesth.Analg. 2003; 97: 572–6.Google Scholar
Gupta, S, Heath, K, Matta, BF: Effect of incremental doses of sevoflurane on cerebral pressure autoregulation in humans. Br.J.Anaesth. 1997; 79: 469–72.CrossRefGoogle ScholarPubMed
Bijker, JB, Persoon, S, Peelen, LM, Moons, KGM, Kalkman, CG, Kappelle, LJ, van Klei, WA: Intraoperative hypotension and perioperative ischemic stroke after general surgery. A nested case-control study. Anesthesiology. 2012; 116: 658–64.Google Scholar
De Wit, F, van Vliet, AL, de Wilde, RB, Jansen, JR, Vuyk, J, Aarts, LP, de Jonge, E, Veelo, DP, Geerts, BF: The effect of propofol on haemodynamics: cardiac output, venous return, mean systemic filling pressure, and vascular resistance. Br.J.Anaesth. 2016; 116 (6): 784–9.Google Scholar
Aono, MI, Sato, J, Nishino, T: Nitrous oxide increases normocapnic cerebral blood flow velocity but does not affect the dynamic cerebrovascular response to step changes in end-tidal P(CO2) in humans. Anesth. Analg. 1999; 89: 684–9.CrossRefGoogle Scholar
Pohl, A, Cullen, DJ: Cerebral ischemia during shoulder surgery in the upright position: a case series. J.Clin.Anesth. 2005; 17: 463–9.Google Scholar
McCulloch, TJ, Boesel, TW, Lam, AM: The effect of hypocapnia on the autoregulation of cerebral blood flow during administration of isoflurane. Anesth.Analg. 2005; 100: 1463–7.Google Scholar

Accessibility standard: Unknown

Why this information is here

This section outlines the accessibility features of this content - including support for screen readers, full keyboard navigation and high-contrast display options. This may not be relevant for you.

Accessibility Information

Accessibility compliance for the PDF of this book is currently unknown and may be updated in the future.

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×