Propofol/Remifentanil Anesthesia Might Not Alter the Middle Cerebral Artery Diameter by Digital Subtraction Angiography

• Published in: Neurocritical care Vol. 31; no. 2; pp. 338 - 345
• Main Authors: Arrigoni-Marocco, Stefano, Engrand, Nicolas, Civelli, Vittorio, Mateo, Joaquim, Labeyrie, Marc-Antoine, Saint-Maurice, Jean-Pierre, Mebazaa, Alexandre, Gayat, Etienne, Houdart, Emmanuel, Vallée, Fabrice
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.10.2019; Springer Nature B.V
• Subjects: Adult; Analgesics, Opioid - therapeutic use; Anesthesia; Anesthesia, General; Anesthetics, Intravenous - therapeutic use; Angiography, Digital Subtraction; Blood Flow Velocity; Blood pressure; Cerebral Angiography; Cerebrovascular Circulation; Critical Care Medicine; Female; Heart rate; Hemodynamics; Humans; Hypertension; Intensive; Internal Medicine; Intubation; Magnetic resonance imaging; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Middle Cerebral Artery - anatomy & histology; Middle Cerebral Artery - diagnostic imaging; Neurology; Organ Size; Original Work; Patients; Propofol - therapeutic use; Radiology, Interventional; Remifentanil - therapeutic use; Retrospective Studies; Sinuses; Stents; Transverse Sinuses; Ultrasonography, Doppler, Transcranial; Veins & arteries; Velocity; Digital subtraction angiography; General anesthesia; Cerebral blood flow; Transcranial Doppler; Middle cerebral artery
• ISSN: 1541-6933; 1556-0961; 1556-0961
• DOI: 10.1007/s12028-019-00699-3

Introduction Transcranial Doppler (TCD) of the middle cerebral artery (MCA) enables the measurement of the mean blood velocity (MCA Vm ) and the estimation of the cerebral blood flow (CBF), provided that no significant changes occur in the MCA diameter (MCA Diam ). Previous studies described a decrease in the MCA Vm associated with the induction of total intravenous anesthesia (TIVA) by propofol and remifentanil. This decrease in blood velocity might be interpreted as a decrease in the CBF only where the MCA Diam is not modified across TCD examinations. Methods In this observational study, we measured the MCA Diam of 24 subjects (almost exclusively females) on digital subtraction angiography under awake and TIVA conditions. Results Across the two phases, we observed a decrease in the mean arterial blood pressure (from 84 ± 9 to 71 ± 6 mmHg; p  < 0.001) and heart rate (76 ± 10 vs. 65 ± 8 beats/min; p  < 0.001), and a concomitant decrease in the MCA Vm (61 vs. 42 cm/s; p  < 0.001). In contrast, the MCA Diam did not vary in association with TIVA (2.3 ± 0.2 vs. 2.3 ± 0.2 mm; p  = 0.52). Conclusions Those results suggested that in this population, no significant changes in the MCA Diam are associated with TIVA.