AUTHOR=Manquat Elsa , Ravaux Hugues , Souilamas Jihane , Chamoux Thibaut , Joaquim Jona , Gayat Etienne , Vallée Fabrice , Cartailler Jérôme 

TITLE=Cerebral autoregulation and cerebral blood flow response to mean arterial pressure challenge following induction of general anaesthesia for neuroradiology procedure

JOURNAL=Frontiers in Anesthesiology

VOLUME=2

YEAR=2023

URL=https://www.frontiersin.org/journals/anesthesiology/articles/10.3389/fanes.2023.1169961

DOI=10.3389/fanes.2023.1169961

ISSN=2813-480X

ABSTRACT=<sec><title>Introduction</title><p>Intraoperative hypotension is common following general anaesthesia induction with propofol, but its impact on cerebral autoregulation (CA) remains unclear. We investigate the incidence and risk factors of impaired CApost-propofol induction and its recovery after a mean arterial pressure (mAP) challenge.</p></sec><sec><title>Methods</title><p>We included 40 non-emergency neuroradiology surgery patients [58 (47, 58)years old., 57% women]. We recorded mAP, mean blood flow velocity in the mean cerebral artery (MCAv<sub>mean</sub>), and regional cerebral oxygen saturation (rSO2). We computed the mean flow index (Mxa) pre and post mAP challenge. Mxa &gt; 0.3 defined poor CA.</p></sec><sec><title>Results</title><p>After anaesthesia induction, 21 (53%) had impaired CBF autoregulation (CA−, Mxa &gt; 0.3). The average mAP was 66 ± 9 mmHg, average MCAv was 39 ± 12 cm.s<sup>−1</sup>, and rSO<sub>2</sub> was 63 ± 7%. We found no significant difference in age, norepinephrine infusion rate, and cardiovascular risks factors were similar between CA− and CA+ (Mxa ≤ 0.3) patients. Among the 22 patients (CA−: <italic>n</italic> = 14; CA+: <italic>n</italic> = 8) undergoing mAP challenge, there was a significant Mxa improvement and MCAv increase among CA− patients, (CA−: 0.63 ± 0.18 vs. 0.28 ± 0.20, <italic>p</italic> &lt; 0.001), and [absolute variation: 1 (0.7–1.5) vs. 7 (3–9) cm.sec<sup>−1</sup>], respectively.</p></sec><sec><title>Conclusion</title><p>After induction of general anaesthesia for neuroradiology procedure, 53% of the patients had an impaired CA, regardless of age or medical history. Importantly, a mAP challenge effectively restored CA and improved CBF.</p></sec><sec><title>Clinical Trial Registration</title><p>identifier, NCT04288869</p></sec>