Abstract
Controlled hypotension is used widely in clinical anesthesia in order to diminish blood loss and to facilitate surgery. There is a considerable area of disagreement about the safety of the technique, but most series reported emphasize the benefits, and few unsatisfactory results are published. The level to which the blood pressure is deliberately reduced is probably critical. Brierley and coworkers (1) showed that reduction of cerebral perfusion pressure to 20 mm Hg very quickly results in ischemic lesions in boundary zones; i.e., the watershed areas in which arterial branching and distance from the supply vessel lead to inadequate flow distribution. Freeman and Ingvar (3) reduced cerebral perfusion pressure to a similar extent by controlled hemorrhage and showed that autoregulation of cerebral blood flow (CBF) was abolished. This level of hypotension is lower than is used clinically.
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References
Brierley, J. B., Brown, A. W., Excell, B. J., and Meldrum, B. S.: “Brain damage in the rhesus monkey resulting from profound arterial hypotension. 1. Its nature, distribution and general physiological correlates.” Brain Res. 13:68–100 (1969).
Eklöf, B., and Siesjö, B. K.: “Cerebral blood flow and cerebral energy state.” Acta Physiol. Scand. 82:409–411 (1971).
Freeman, J., and Ingvar, D. H.: “Elimination by hypoxia of cerebral blood flow autoregulation and EEG relationship.” Exp. Brain Res. 5:61–71 (1968).
Keaney, N. P., McDowall, D. G., Turner, J. M., Lane, J. R., and Okuda, Y. (in preparation).
Nilsson, L., and Siesjö, B. K.: “The effect of deep halothane hypotension upon labile phosphates and upon extra- and intracellular lactate and pyruvate concentrations in the rat brain.” Acta Physiol. Scand. 81:508–516 (1971).
Severinghaus, J. W.: “Blood gas calculator.” J. Appl. Physiol. 21:1108–1116 (1966).
Yashon, D., Stone, W., Magness, A., Hunt, W. E., and Hamelberg, W.: “Halothane associated preservation of aerobic cerebral processes during profound arterial hypotension.” Sixth Intern. CBF Symp., Philadelphia, June 1973 (this volume, p. 349).
Zwetnow, N.: “Effects of intracranial hypertension: acid base changes and lactate changes in CSF and brain tissue.” Scand. J. Clin. Lab. Invest. Suppl. 102, IIID (1968).
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© 1975 Springer-Verlag New York Inc.
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Keaney, N.P. et al. (1975). Cerebral Blood Flow Autoregulation, Cerebrospinal Fluid Acid-Base Parameters, and Profound Hypotension Induced by Sodium Nitroprusside and Deep Halothane Anesthesia. In: Langfitt, T.W., McHenry, L.C., Reivich, M., Wollman, H. (eds) Cerebral Circulation and Metabolism. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-65814-3_6
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DOI: https://doi.org/10.1007/978-3-642-65814-3_6
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