title: Middle cerebral O₂ delivery during the modified Oxford maneuver increases with sodium nitroprusside and decreases during phenylephrine.
abstract: The modified Oxford maneuver is the reference standard for assessing arterial baroreflex function. The maneuver comprises a systemic bolus injection of 100 μg sodium nitroprusside (SNP) followed by 150 μg phenylephrine (PE). On the one hand, this results in an increase in oxyhemoglobin and total hemoglobin followed by a decrease within the cerebral sample volume illuminated by near-infrared spectroscopy (NIRS). On the other hand, it produces a decrease in cerebral blood flow velocity (CBFv) within the middle cerebral artery (MCA) during SNP and an increase in CBFv during PE as measured by transcranial Doppler ultrasound. To resolve this apparent discrepancy, we hypothesized that SNP dilates, whereas PE constricts, the MCA. We combined transcranial Doppler ultrasound of the right MCA with NIRS illuminating the right frontal cortex in 12 supine healthy subjects 18-24 yr old. Assuming constant O₂ consumption and venous saturation, as estimated by partial venous occlusion plethysmography, we used conservation of mass (continuity) equations to estimate the changes in arterial inflow (ΔQa) and venous outflow (ΔQv) of the NIRS-illuminated area. Oxyhemoglobin and total hemoglobin, respectively, increased by 13.6 ± 1.6 and 15.2 ± 1.4 μmol/kg brain tissue with SNP despite hypotension and decreased by 6 ± 1 and 7 ± 1 μmol/kg with PE despite hypertension. SNP increased ΔQa by 0.36 ± .03 μmol·kg(-1)·s(-1) (21.6 μmol·kg(-1)·min(-1)), whereas CBFv decreased from 71 ± 2 to 62 ± 2 cm/s. PE decreased ΔQa by 0.27 ± .2 μmol·kg(-1)·s(-1) (16.2 μmol·kg(-1)·min(-1)), whereas CBFv increased to 75 ± 3 cm/s. These results are consistent with dilation of the MCA by SNP and constriction by PE.
authors.affiliation: Department of Pediatrics, New York Medical College, Valhalla, NY, USA. julian_stewart@nymc.edu
authors.forename: Julian M
authors.initials: JM
authors.lastname: Stewart
authors.forename: Marvin S
authors.initials: MS
authors.lastname: Medow
authors.forename: Andrew
authors.initials: A
authors.lastname: DelPozzi
authors.forename: Zachary R
authors.initials: ZR
authors.lastname: Messer
authors.forename: Courtney
authors.initials: C
authors.lastname: Terilli
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Schwartz
mesh_terms: D000293:Adolescent; D000465:Algorithms; D062186:Arterial Pressure / Q000187:drug effects; D001808:Blood Vessels / Q000033:anatomy & histology / Q000502:physiology; D002560:Cerebrovascular Circulation / Q000187:drug effects; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D020768:Middle Cerebral Artery / Q000502:physiology*; D009599:Nitroprusside / Q000494:pharmacology*; D010101:Oxygen Consumption / Q000187:drug effects* / Q000502:physiology*; D010656:Phenylephrine / Q000494:pharmacology*; D019265:Spectroscopy, Near-Infrared; D016683:Supine Position / Q000502:physiology; D017585:Ultrasonography, Doppler, Transcranial; D014662:Vasoconstrictor Agents / Q000494:pharmacology*; D014665:Vasodilator Agents / Q000494:pharmacology*; D055815:Young Adult
chemical_list: D006454:Hemoglobins; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D009599:Nitroprusside; D010656:Phenylephrine
keywords: cerebral blood flow; middle cerebral artery; near-infrared spectroscopy; nitric oxide; vasodilation
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