Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-19T06:50:05.908Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Lovell, AT, Owen-Reece, H, Elwell, CE et al. . Continuous measurement of cerebral oxygenation by near infrared spectroscopy during induction of anesthesia. Anesth Analg 1999; 88: 554–558.Google ScholarPubMed
2.Akbar, AN, Muzi, M, Lopatka, CW, Ebert, TJ. Neurocirculatory responses to intubation with either an endotracheal tube or laryngeal mask airway in humans. J Clin Anesth 1996; 8: 194–197.CrossRefGoogle ScholarPubMed
3.Dahaba, AA, Prax, N, Gaube, W et al. . Haemodynamic and catecholamine stress responses to the laryngeal tube-suction airway and the proseal laryngeal mask airway. Anaesthesia 2006; 61: 330–334.CrossRefGoogle Scholar
4.Choi, J, Wolf, M, Toronov, V et al. . Noninvasive determination of the optical properties of adult brain: near-infrared spectroscopy approach. J Biomed Opt 2004; 9: 221–229.CrossRefGoogle ScholarPubMed
5.Li, CS, Kosten, TR, Sinha, R. Sex differences in brain activation during stress imagery in abstinent cocaine users: a functional magnetic resonance imaging study. Biol Psychiatry 2005; 57: 487–494.CrossRefGoogle ScholarPubMed
6.Buxton, RB, Uludag, K, Dubowitz, DJ, Liu, TT. Modeling the hemodynamic response to brain activation. Neuroimage 2004; 23 (Suppl 1): S220–S233.CrossRefGoogle ScholarPubMed
7.Bunting, HE, Kelly, MC, Milligan, KR. Effect of nebulized lignocaine on airway irritation and haemodynamic changes during induction of anaesthesia with desflurane. Br J Anaesth 1995; 75: 631–633.CrossRefGoogle ScholarPubMed
8.Toronov, V, Walker, S, Gupta, R et al. . The roles of changes in deoxyhemoglobin concentration and regional cerebral blood volume in the fMRI BOLD signal. Neuroimage 2003; 19: 1521–1531.CrossRefGoogle ScholarPubMed
9.Huppert, TJ, Hoge, RD, Diamond, SG et al. . A temporal comparison of BOLD, ASL, and NIRS hemodynamic responses to motor stimuli in adult humans. Neuroimage 2006; 29: 368–382.CrossRefGoogle ScholarPubMed
10.Li, CS, Sinha, R. Alexithymia and stress-induced brain activation in cocaine-dependent men and women. J Psychiatry Neurosci 2006; 31: 115–121.Google ScholarPubMed
11.Peeters, RR, Tindemans, I, De Schutter, E, Van der Linden, A. Comparing BOLD fMRI signal changes in the awake and anesthetized rat during electrical forepaw stimulation. Magn Reson Imaging 2001; 19: 821–826.CrossRefGoogle ScholarPubMed
12.Licker, M, Farinelli, C, Klopfenstein, CE. Cardiovascular reflexes during anesthesia induction and tracheal intubation in elderly patients: the influence of thoracic epidural anesthesia. J Clin Anesth 1995; 7: 281–287.CrossRefGoogle Scholar
13.Schwarz, G, Litscher, G, Kleinert, R, Jobstmann, R. Cerebral oximetry in dead subjects. J Neurosurg Anesthesiol 1996; 8: 189–193.CrossRefGoogle ScholarPubMed
14.Gatto, R, Hoffman, W, Mueller, M et al. . Frequency domain near-infrared spectroscopy technique in the assessment of brain oxygenation: a validation study in live subjects and cadavers. J Neurosci Methods 2006; 157: 274–277.CrossRefGoogle ScholarPubMed
15.Fantini, S, Hueber, D, Franceschini, MA et al. . Non-invasive optical monitoring of the newborn piglet brain using continuous-wave and frequency-domain spectroscopy. Phys Med Biol 1999; 44: 1543–1563.CrossRefGoogle ScholarPubMed
16.Tanner, K, D’Amico, E, Kaczmarowski, A et al. . Spectrally resolved neurophotonics: a case report of hemodynamics and vascular components in the mammalian brain. J Biomed Opt 2005; 10: 064009.CrossRefGoogle ScholarPubMed
17.Weiskopf, RB, Moore, MA, Eger 2nd, EI et al. . Rapid increase in desflurane concentration is associated with greater transient cardiovascular stimulation than with rapid increase in isoflurane concentration in humans. Anesthesiology 1994; 80: 1035–1045.CrossRefGoogle ScholarPubMed
18.Matta, BF, Mayberg, TS, Lam, AM. Direct cerebrovasodilatory effects of halothane, isoflurane, and desflurane during propofol-induced isoelectric electroencephalogram in humans. Anesthesiology 1995; 83: 980–985; discussion 27A.CrossRefGoogle ScholarPubMed