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Increased brain oxygenation during intubation-related stress

Published online by Cambridge University Press:  01 December 2007

C. Paisansathan ,
W. E. Hoffman ,
R. G. Gatto ,
V. L. Baughman ,
M. Mueller  and
F. T. Charbel
C. Paisansathan
Affiliation:
University of Illinois at Chicago, Department of Anesthesia, Chicago, IL, USA
W. E. Hoffman*
Affiliation:
University of Illinois at Chicago, Department of Anesthesia, Chicago, IL, USA
R. G. Gatto
Affiliation:
University of Illinois at Chicago, Department of Neurosurgery, Chicago, IL, USA
V. L. Baughman
Affiliation:
University of Illinois at Chicago, Department of Anesthesia, Chicago, IL, USA
M. Mueller
Affiliation:
University of Illinois at Chicago, Department of Anesthesia, Chicago, IL, USA
F. T. Charbel
Affiliation:
University of Illinois at Chicago, Department of Neurosurgery, Chicago, IL, USA
*
Correspondence to: William E. Hoffman, Department of Anesthesiology, University of Illinois at Chicago, 1740 W Taylor, Suite 3200, Chicago, IL 60612, USA. E-mail: whoffman@uic.edu; Tel: +1 312 996 4019; Fax: +1 312 996 4019
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Summary

Background and objectives

The purpose of this study was to determine whether brain oxyhaemoglobin–deoxyhaemoglobin coupling was altered by anaesthesia or intubation-induced stress.

Methods

This was a prospective observational study in the operating room. Thirteen patients (ASA I and II) undergoing spinal or peripheral nerve procedures were recruited. They were stabilized before surgery with mask ventilation of 100% oxygen. Anaesthesia was induced with 2 μg kg−1 fentanyl and 3 mg kg−1 thiopental. Laryngoscopy and intubation were performed 4 min later. After intubation, desflurane anaesthesia (FiO2=1.0) was adjusted to maintain response entropy of the electroencephalogram at 40–45 for 20 min. Prefrontal cortex oxyhaemoglobin and deoxyhaemoglobin were determined every 2 s using frequency domain near-infrared spectroscopy. Blood pressure, heart rate and response entropy were collected every 10 s.

Results

Awake oxyhaemoglobin and deoxyhaemoglobin were 18.9 ± 2.3 μmol (mean ± SD) and 12.7 ± 0.8 μmol, respectively, and neither changed significantly during induction. Intubation increased oxyhaemoglobin by 37% (P < 0.05) and decreased deoxyhaemoglobin by 16% (P < 0.05), and both measures returned to baseline within 20 min of desflurane anaesthesia. Blood pressure, heart rate and electroencephalogram response entropy increased during intubation, and the increase in heart rate correlated with the increase in brain oxygen saturation (r = 0.48, P < 0.05).

Conclusions

Intubation-related stress increased oxyhaemoglobin related to electroencephalogram and autonomic activation. Stress-induced brain stimulation may be monitored during anaesthesia using frequency domain near-infrared spectroscopy.

Keywords

SPECTROSCOPY NEAR INFRAREDHYPOXIABRAINBLOOD FLOWREGIONALANAESTHESIA GENERALELECTROENCEPHALOGRAM, entropy
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 12 , December 2007 , pp. 1016 - 1020
Copyright
Copyright © European Society of Anaesthesiology 2007

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