| Intraoperative monitoring of cerebral microcirculation and oxygenation--a feasibility study using a novel photo-spectrometric laser-Doppler flowmetry. | |
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MedLine Citation:
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PMID: 19816204 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The present study assesses the utility of a novel invasive device (O2C-, oxygen-to-see-device) for intraoperative measurement of the cerebral microcirculation. CO2 vasoreactivity during 2 different propofol concentrations was used to investigate changes of capillary venous cerebral blood flow (rvCBF), oxygen saturation (srvO2), and hemoglobin concentration (rvHb) during craniotomy. METHODS: Thirty-four patients were randomly assigned to a low propofol (4 mg/kg/h) versus a high propofol (6 mg/kg/h) group. A fiberoptic probe was applied on the cortex next to the surgical site. Measurements were performed during lower (35 mm Hg) and higher (45 mm Hg) levels of partial pressure of carbon dioxide (paCO2). Arterio-venous difference in oxygen concentration (avDO2) and approximated cerebral metabolic rate of oxygen (aCMRO2) were calculated for each paCO2 state. Linear models were fitted to test changes of end points in response to paCO2 and propofol concentration. RESULTS: In comparison to the lower levels of paCO2, higher levels of paCO2 increased rvCBF (P<0.001), and srvO2 (P=0.002). RvHb remained unchanged during measurements (P=0.325). Calculated avDO2 decreased with increasing paCO2 (P<0.001), whereas aCMRO2 did not change during the study (P=0.999). Propofol concentration had no effect on measured or calculated end points. CONCLUSIONS: Increase of rvCBF by paCO2 indicates a preserved CO2 reactivity independent of propofol anesthesia. The consecutive rise in srvO2 implies enhanced oxygen availability due to vasodilatation. Unchanged rvHb represents constant venous hemoglobin concentration. As expected, calculated avDO2 decreases with increased paCO2, whereas aCMRO2 remains unchanged. Despite the promising technical approach, the technology needs validation and further investigation for usage during neurosurgery. |
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Authors:
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Klaus Ulrich Klein; Patrick Schramm; Martin Glaser; Robert Reisch; Achim Tresch; Christian Werner; Kristin Engelhard |
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Publication Detail:
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Type: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of neurosurgical anesthesiology Volume: 22 ISSN: 1537-1921 ISO Abbreviation: J Neurosurg Anesthesiol Publication Date: 2010 Jan |
Date Detail:
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Created Date: 2009-12-22 Completed Date: 2010-03-30 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8910749 Medline TA: J Neurosurg Anesthesiol Country: United States |
Other Details:
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Languages: eng Pagination: 38-45 Citation Subset: IM |
Affiliation:
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Department of Anesthesiology, University Hospital Medical Center, Johannes Gutenberg University, Mainz, Germany. kuklein@unimainz.de |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Anesthetics, Intravenous / pharmacology Blood Flow Velocity / drug effects Brain / blood supply*, drug effects, metabolism Carbon Dioxide / metabolism Craniotomy / methods Dose-Response Relationship, Drug Feasibility Studies Female Fiber Optic Technology Germany Hemoglobins / drug effects Humans Laser-Doppler Flowmetry / methods* Male Microcirculation / drug effects* Middle Aged Monitoring, Intraoperative / methods* Oxygen / metabolism* Photometry / methods Propofol / administration & dosage* Spectrum Analysis / methods |
| Chemical | |
Reg. No./Substance:
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0/Anesthetics, Intravenous; 0/Hemoglobins; 124-38-9/Carbon Dioxide; 2078-54-8/Propofol; 7782-44-7/Oxygen |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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