title: Effect of age on intraoperative cerebrovascular autoregulation and near-infrared spectroscopy-derived cerebral oxygenation.
abstract: BACKGROUND
  Age is an important risk factor for perioperative cerebral complications such as stroke, postoperative cognitive dysfunction, and delirium. We explored the hypothesis that intraoperative cerebrovascular autoregulation is less efficient and brain tissue oxygenation lower in elderly patients, thus, increasing the vulnerability of elderly brains to systemic insults such as hypotension.
  
  
  METHODS
  We monitored intraoperative cerebral perfusion in 50 patients aged 18-40 and 77 patients >65 yr at two Swiss university hospitals. Mean arterial pressure (MAP) was measured continuously using a plethysmographic method. An index of cerebrovascular autoregulation (Mx) was calculated based on changes in transcranial Doppler flow velocity due to changes in MAP. Cerebral oxygenation was assessed by the tissue oxygenation index (TOI) using near-infrared spectroscopy. End-tidal CO₂, O₂, and sevoflurane concentrations and peripheral oxygen saturation were recorded continuously. Standardized anaesthesia was administered in all patients (thiopental, sevoflurane, fentanyl, atracurium).
  
  
  RESULTS
  Autoregulation was less efficient in patients aged >65 yr [by 0.10 (se 0.04; P=0.020)] in a multivariable linear regression analysis. This difference was not attributable to differences in MAP, end-tidal CO₂, or higher doses of sevoflurane. TOI was not significantly associated with age, sevoflurane dose, or Mx but increased with increasing flow velocity [by 0.09 (se 0.04; P=0.028)] and increasing MAP [by 0.11 (se 0.05; P=0.043)].
  
  
  CONCLUSIONS
  Our results do not support the hypothesis that older patients' brains are more vulnerable to systemic insults. The difference of autoregulation between the two groups was small and most likely clinically insignificant.
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, University Hospital Basel, Switzerland.
authors.forename: C S
authors.initials: CS
authors.lastname: Burkhart
authors.forename: A
authors.initials: A
authors.lastname: Rossi
authors.forename: S
authors.initials: S
authors.lastname: Dell-Kuster
authors.forename: M
authors.initials: M
authors.lastname: Gamberini
authors.forename: A
authors.initials: A
authors.lastname: Möckli
authors.forename: M
authors.initials: M
authors.lastname: Siegemund
authors.forename: M
authors.initials: M
authors.lastname: Czosnyka
authors.forename: S P
authors.initials: SP
authors.lastname: Strebel
authors.forename: L A
authors.initials: LA
authors.lastname: Steiner
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D001794:Blood Pressure; D001921:Brain / Q000098:blood supply / Q000378:metabolism*; D002245:Carbon Dioxide / Q000378:metabolism; D002560:Cerebrovascular Circulation; D006706:Homeostasis; D006801:Humans; D017078:Laser-Doppler Flowmetry / Q000379:methods; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D010100:Oxygen / Q000378:metabolism*; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D055815:Young Adult
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen