Ultrasound tagged near infrared spectroscopy does not detect hyperventilation-induced reduction in cerebral blood flow.
BACKGROUND
Continuous non-invasive monitoring of cerebral blood flow (CBF) may be important during anaesthesia and several options are available. We evaluated the CerOx monitor that employs ultrasound tagged near infrared spectroscopy to estimate changes in a CBF index (CFI).


METHODS
Seven healthy males (age 21-26 years) hyperventilated and were administered phenylephrine to increase mean arterial pressure by 20-30 mmHg. Frontal lobe tissue oxygenation (ScO2) and CFI were obtained using the CerOx and mean blood flow velocity in the middle cerebral artery (MCAv mean) was determined by transcranial Doppler. Blood flow in the internal and external carotid artery (ICAf and ECAf) was determined using duplex ultrasonography and forehead skin blood flow (SkBF) and oxygenation (S skin O2) by laser Doppler and white light spectroscopy.


RESULTS
During hyperventilation MCAv mean and ICAf decreased by 44% (median; interquartile range 40-49; p = 0.016) and 46% (40-53; p = 0.03), respectively. Conversely, CFI increased by 9% (2-31; p = 0.016), while no significant change was observed in ScO2. SkBF increased by 19% (9-53; p = 0.016) and S skin O2 by 6% (1-7; p = 0.047), although ECAf was unchanged. Administration of phenylephrine was not associated with any changes in MCAv mean, ICAf, ECAf, ScO2, SkBF, S skin O2, or CFI.


CONCLUSIONS
The CerOx was able to detect a stable CBF during administration of phenylephrine. However, during hyperventilation MCAv mean and ICAf decreased while CFI increased, likely due to an increase in superficial tissue oxygenation. Thus, CFI does not provide an unbiased evaluation of changes in CBF.
a Department of Neuroanaesthesia.
Anton
A
Lund
b The Copenhagen Muscle Research Centre, Department of Anaesthesia, Rigshospitalet , University of Copenhagen , Denmark.
Niels H
NH
Secher
c Emergency Department, School of Medicine , Kyorin University , Mitaka-Shi , Tokyo , Japan.
Ai
A
Hirasawa
d Department of Biomedical Engineering, Faculty of Science and Engineering , Toyo University , Kawagoe-Shi, Saitama , Japan.
Shigehiko
S
Ogoh
e Graduate School of Sport and Health Science , Ritsumeikan University , Shiga , Japan.
Takeshi
T
Hashimoto
f Department of Neurology, Rigshospitalet Glostrup , University of Copenhagen , Denmark.
Henrik W
HW
Schytz
f Department of Neurology, Rigshospitalet Glostrup , University of Copenhagen , Denmark.
Messoud
M
Ashina
b The Copenhagen Muscle Research Centre, Department of Anaesthesia, Rigshospitalet , University of Copenhagen , Denmark.
Henrik
H
Sørensen
D000328:Adult; D001783:Blood Flow Velocity; D002342:Carotid Artery, External / Q000000981:diagnostic imaging; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D002560:Cerebrovascular Circulation / Q000187:drug effects; D006801:Humans; D006985:Hyperventilation / Q000097:blood* / Q000188:drug therapy; D008297:Male; D020768:Middle Cerebral Artery; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D010100:Oxygen / Q000097:blood; D010656:Phenylephrine / Q000627:therapeutic use; D019265:Spectroscopy, Near-Infrared / Q000295:instrumentation / Q000379:methods*; D018616:Ultrasonography, Doppler, Duplex / Q000295:instrumentation / Q000379:methods*; D017585:Ultrasonography, Doppler, Transcranial / Q000295:instrumentation / Q000379:methods; D055815:Young Adult
D010656:Phenylephrine; D010100:Oxygen
Cerebral oximetry; external carotid artery; internal carotid artery; monitoring; skin blood flow; skin oxygen saturation