Application of transcranial Doppler monitoring cerebral blood flow in operation with anesthesia_West China Medical Journal

Authors：

WANG Mengyan ,  ZUO Yunxia

Anesthesia & Operation Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

ZUO Yunxia, Email: zuoyunxia@scu.edu.cn

Keywords：

Perioperative; cerebral blood flow; transcranial Doppler

DOI：

10.7507/1002-0179.202107218

Video：

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There are a variety of invasive or non-invasive methods for monitoring cerebral blood flow and cerebral metabolism in patients during operation with anesthesia, and different methods have their own scope of use. Transcranial Doppler can be used to monitor high-risk patients with intraoperative cerebral blood flow autoregulation dysfunction and patients with special positions during operation because of its convenience, continuity, and strong repeatability. Changes in cerebral blood flow detected by transcranial Doppler may be associated with postoperative central nervous system complications in patients. This article reviews the application of transcranial Doppler monitoring of cerebral blood flow in operation with anesthesia, aiming to provide a certain basis for the promotion of this technology in operation with anesthesia.

Citation： WANG Mengyan, ZUO Yunxia. Application of transcranial Doppler monitoring cerebral blood flow in operation with anesthesia. West China Medical Journal, 2022, 37(1): 131-134. doi: 10.7507/1002-0179.202107218 Copy

1.	Patel N, Horsfield MA, Banahan C, et al. Impact of perioperative infarcts after cardiac surgery. Stroke, 2015, 46(3): 680-686.
2.	Vlisides P, Mashour GA. Perioperative stroke. Can J Anaesth, 2016, 63(2): 193-204.
3.	Subramaniyan S, Terrando N. Neuroinflammation and perioperative neurocognitive disorders. Anesth Analg, 2019, 128(4): 781-788.
4.	Casati A, Fanelli G, Pietropaoli P, et al. Continuous monitoring of cerebral oxygen saturation in elderly patients undergoing major abdominal surgery minimizes brain exposure to potential hypoxia. Anesth Analg, 2005, 101(3): 740-747.
5.	Tang L, Kazan R, Taddei R, et al. Reduced cerebral oxygen saturation during thoracic surgery predicts early postoperative cognitive dysfunction. Br J Anaesth, 2012, 108(4): 623-629.
6.	胡裕, 韩阳东, 王宁, 等. 围手术期脑血流灌注的常用监测方法及进展. 医学综述, 2020, 26(9): 1770-1775.
7.	Stover JF. Contemporary view on neuromonitoring following severe traumatic brain injury. World J Crit Care Med, 2012, 1(1): 15-22.
8.	Guven M, Akilli NB, Koylu R, et al. A new marker identification of high risk stroke patients: Jugular saturation. Am J Emerg Med, 2020, 38(1): 7-11.
9.	Hu Z, Xu L, Zhu Z, et al. Effects of hypothermic cardiopulmonary bypass on internal jugular bulb venous oxygen saturation, cerebral oxygen saturation, and bispectral index in pediatric patients undergoing cardiac surgery: a prospective study. Medicine (Baltimore), 2016, 95(2): e2483.
10.	D’Andrea A, Conte M, Scarafile R, et al. Transcranial doppler ultrasound: physical principles and principal applications in neurocritical care unit. J Cardiovasc Echogr, 2016, 26(2): 28-41.
11.	Rasulo FA, Bertuetti R. Transcranial doppler and optic nerve sonography. J Cardiothorac Vasc Anesth, 2019, 33(Suppl 1): S38-S52.
12.	Sorteberg W, Lindegaard KF, Rootwelt K, et al. Blood velocity and regional blood flow in defined cerebral artery systems. Acta Neurochir (Wien), 1989, 97(1/2): 47-52.
13.	Greene SA. Anesthesia for patients with neurologic disease. Top Companion Anim Med, 2010, 25(2): 83-86.
14.	Kolesnykov V, Loskutov O, Druzhyna O, et al. Features of cerebral blood flow dynamics in patients with arterial hypertension during cardiac surgery. Georgian Med News, 2019(286): 13-19.
15.	Meng L, Gelb AW. Regulation of cerebral autoregulation by carbon dioxide. Anesthesiology, 2015, 122(1): 196-205.
16.	Tan CO. Defining the characteristic relationship between arterial pressure and cerebral flow. J Appl Physiol (1985), 2012, 113(8): 1194-1200.
17.	Brady K, Joshi B, Zweifel C, et al. Real-time continuous monitoring of cerebral blood flow autoregulation using near-infrared spectroscopy in patients undergoing cardiopulmonary bypass. Stroke, 2010, 41(9): 1951-1956.
18.	Hori D, Hogue C, Adachi H, et al. Perioperative optimal blood pressure as determined by ultrasound tagged near infrared spectroscopy and its association with postoperative acute kidney injury in cardiac surgery patients. Interact Cardiovasc Thorac Surg, 2016, 22(4): 445-451.
19.	Zheng Y, Villamayor AJ, Merritt W, et al. Continuous cerebral blood flow autoregulation monitoring in patients undergoing liver transplantation. Neurocrit Care, 2012, 17(1): 77-84.
20.	Fudickar A, Leiendecker J, Köhling A, et al. Transcranial Doppler sonography as a potential screening tool for preanaesthetic evaluation: a prospective observational study. Eur J Anaesthesiol, 2012, 29(10): 471-476.
21.	Hanouz JL, Fiant AL, Gérard JL. Middle cerebral artery blood flow velocity during beach chair position for shoulder surgery under general anesthesia. J Clin Anesth, 2016, 33: 31-36.
22.	Aguirre JA, Etzensperger F, Brada M, et al. The beach chair position for shoulder surgery in intravenous general anesthesia and controlled hypotension: impact on cerebral oxygenation, cerebral blood flow and neurobehavioral outcome. J Clin Anesth, 2019, 53: 40-48.
23.	Weintraub MI, Khoury A. Cerebral hemodynamic changes induced by simulated tracheal intubation: a possible role in perioperative stroke? Magnetic resonance angiography and flow analysis in 160 cases. Stroke, 1998, 29(8): 1644-1649.
24.	Saraçoğlu A, Altun D, Yavru A, et al. Effects of head position on cerebral oxygenation and blood flow velocity during thyroidectomy. Turk J Anaesthesiol Reanim, 2016, 44(5): 241-246.
25.	Kose G, Hatipoglu S. Effect of head and body positioning on cerebral blood flow velocity in patients who underwent cranial surgery. J Clin Nurs, 2012, 21(13/14): 1859-1867.
26.	Kondrashova T, Makar M, Proctor C, et al. Dynamic assessment of cerebral blood flow and intracranial pressure during inversion table tilt using ultrasonography. J Neurol Sci, 2019, 404: 150-156.
27.	Cottrell JE, Hartung J. Developmental disability in the young and postoperative cognitive dysfunction in the elderly after anesthesia and surgery: do data justify changing clinical practice?. Mt Sinai J Med, 2012, 79(1): 75-94.
28.	Kampf S, Schramm P, Klein KU. Transcranial doppler and near infrared spectroscopy in the perioperative period. Curr Opin Anaesthesiol, 2013, 26(5): 543-548.
29.	Yu Q, Qi J, Wang Y. Intraoperative hypotension and neurological outcomes. Curr Opin Anaesthesiol, 2020, 33(5): 646-650.
30.	Jørgensen LG. Transcranial Doppler ultrasound for cerebral perfusion. Acta Physiol Scand Suppl, 1995, 625: 1-44.
31.	Spencer MP. Transcranial Doppler monitoring and causes of stroke from carotid endarterectomy. Stroke, 1997, 28(4): 685-691.
32.	Yu S, Li P. Cognitive declines after perioperative covert stroke: Recent advances and perspectives. Curr Opin Anaesthesiol, 2020, 33(5): 651-654.
33.	Best LM, Webb AC, Gurusamy KS, et al. Transcranial Doppler ultrasound detection of microemboli as a predictor of cerebral events in patients with symptomatic and asymptomatic carotid disease: a systematic review and meta-analysis. Eur J Vasc Endovasc Surg, 2016, 52(5): 565-580.
34.	Gaunt ME, Martin PJ, Smith JL, et al. Clinical relevance of intraoperative embolization detected by transcranial Doppler ultrasonography during carotid endarterectomy: a prospective study of 100 patients. Br J Surg, 1994, 81(10): 1435-1439.
35.	Warner DS. Anesthetics provide limited but real protection against acute brain injury. J Neurosurg Anesthesiol, 2004, 16(4): 303-307.
36.	Bernardi MH, Wahrmann M, Dworschak M, et al. Carotid artery blood flow velocities during open-heart surgery and its association with delirium: a prospective, observational pilot study. Medicine (Baltimore), 2019, 98(50): e18234.
37.	玉红, 梁鹏, 余海, 等. 围术期超声—新时代麻醉科医师的基本技能. 临床麻醉学杂志, 2018, 34(8): 824-826.
38.	Han SJ, Rutledge WC, Englot DJ, et al. The presto 1000: a novel automated transcranial Doppler ultrasound system. J Clin Neurosci, 2015, 22(11): 1771-1775.

1. Patel N, Horsfield MA, Banahan C, et al. Impact of perioperative infarcts after cardiac surgery. Stroke, 2015, 46(3): 680-686.
2. Vlisides P, Mashour GA. Perioperative stroke. Can J Anaesth, 2016, 63(2): 193-204.
3. Subramaniyan S, Terrando N. Neuroinflammation and perioperative neurocognitive disorders. Anesth Analg, 2019, 128(4): 781-788.
4. Casati A, Fanelli G, Pietropaoli P, et al. Continuous monitoring of cerebral oxygen saturation in elderly patients undergoing major abdominal surgery minimizes brain exposure to potential hypoxia. Anesth Analg, 2005, 101(3): 740-747.
5. Tang L, Kazan R, Taddei R, et al. Reduced cerebral oxygen saturation during thoracic surgery predicts early postoperative cognitive dysfunction. Br J Anaesth, 2012, 108(4): 623-629.
6. 胡裕, 韩阳东, 王宁, 等. 围手术期脑血流灌注的常用监测方法及进展. 医学综述, 2020, 26(9): 1770-1775.
7. Stover JF. Contemporary view on neuromonitoring following severe traumatic brain injury. World J Crit Care Med, 2012, 1(1): 15-22.
8. Guven M, Akilli NB, Koylu R, et al. A new marker identification of high risk stroke patients: Jugular saturation. Am J Emerg Med, 2020, 38(1): 7-11.
9. Hu Z, Xu L, Zhu Z, et al. Effects of hypothermic cardiopulmonary bypass on internal jugular bulb venous oxygen saturation, cerebral oxygen saturation, and bispectral index in pediatric patients undergoing cardiac surgery: a prospective study. Medicine (Baltimore), 2016, 95(2): e2483.
10. D’Andrea A, Conte M, Scarafile R, et al. Transcranial doppler ultrasound: physical principles and principal applications in neurocritical care unit. J Cardiovasc Echogr, 2016, 26(2): 28-41.
11. Rasulo FA, Bertuetti R. Transcranial doppler and optic nerve sonography. J Cardiothorac Vasc Anesth, 2019, 33(Suppl 1): S38-S52.
12. Sorteberg W, Lindegaard KF, Rootwelt K, et al. Blood velocity and regional blood flow in defined cerebral artery systems. Acta Neurochir (Wien), 1989, 97(1/2): 47-52.
13. Greene SA. Anesthesia for patients with neurologic disease. Top Companion Anim Med, 2010, 25(2): 83-86.
14. Kolesnykov V, Loskutov O, Druzhyna O, et al. Features of cerebral blood flow dynamics in patients with arterial hypertension during cardiac surgery. Georgian Med News, 2019(286): 13-19.
15. Meng L, Gelb AW. Regulation of cerebral autoregulation by carbon dioxide. Anesthesiology, 2015, 122(1): 196-205.
16. Tan CO. Defining the characteristic relationship between arterial pressure and cerebral flow. J Appl Physiol (1985), 2012, 113(8): 1194-1200.
17. Brady K, Joshi B, Zweifel C, et al. Real-time continuous monitoring of cerebral blood flow autoregulation using near-infrared spectroscopy in patients undergoing cardiopulmonary bypass. Stroke, 2010, 41(9): 1951-1956.
18. Hori D, Hogue C, Adachi H, et al. Perioperative optimal blood pressure as determined by ultrasound tagged near infrared spectroscopy and its association with postoperative acute kidney injury in cardiac surgery patients. Interact Cardiovasc Thorac Surg, 2016, 22(4): 445-451.
19. Zheng Y, Villamayor AJ, Merritt W, et al. Continuous cerebral blood flow autoregulation monitoring in patients undergoing liver transplantation. Neurocrit Care, 2012, 17(1): 77-84.
20. Fudickar A, Leiendecker J, Köhling A, et al. Transcranial Doppler sonography as a potential screening tool for preanaesthetic evaluation: a prospective observational study. Eur J Anaesthesiol, 2012, 29(10): 471-476.
21. Hanouz JL, Fiant AL, Gérard JL. Middle cerebral artery blood flow velocity during beach chair position for shoulder surgery under general anesthesia. J Clin Anesth, 2016, 33: 31-36.
22. Aguirre JA, Etzensperger F, Brada M, et al. The beach chair position for shoulder surgery in intravenous general anesthesia and controlled hypotension: impact on cerebral oxygenation, cerebral blood flow and neurobehavioral outcome. J Clin Anesth, 2019, 53: 40-48.
23. Weintraub MI, Khoury A. Cerebral hemodynamic changes induced by simulated tracheal intubation: a possible role in perioperative stroke? Magnetic resonance angiography and flow analysis in 160 cases. Stroke, 1998, 29(8): 1644-1649.
24. Saraçoğlu A, Altun D, Yavru A, et al. Effects of head position on cerebral oxygenation and blood flow velocity during thyroidectomy. Turk J Anaesthesiol Reanim, 2016, 44(5): 241-246.
25. Kose G, Hatipoglu S. Effect of head and body positioning on cerebral blood flow velocity in patients who underwent cranial surgery. J Clin Nurs, 2012, 21(13/14): 1859-1867.
26. Kondrashova T, Makar M, Proctor C, et al. Dynamic assessment of cerebral blood flow and intracranial pressure during inversion table tilt using ultrasonography. J Neurol Sci, 2019, 404: 150-156.
27. Cottrell JE, Hartung J. Developmental disability in the young and postoperative cognitive dysfunction in the elderly after anesthesia and surgery: do data justify changing clinical practice?. Mt Sinai J Med, 2012, 79(1): 75-94.
28. Kampf S, Schramm P, Klein KU. Transcranial doppler and near infrared spectroscopy in the perioperative period. Curr Opin Anaesthesiol, 2013, 26(5): 543-548.
29. Yu Q, Qi J, Wang Y. Intraoperative hypotension and neurological outcomes. Curr Opin Anaesthesiol, 2020, 33(5): 646-650.
30. Jørgensen LG. Transcranial Doppler ultrasound for cerebral perfusion. Acta Physiol Scand Suppl, 1995, 625: 1-44.
31. Spencer MP. Transcranial Doppler monitoring and causes of stroke from carotid endarterectomy. Stroke, 1997, 28(4): 685-691.
32. Yu S, Li P. Cognitive declines after perioperative covert stroke: Recent advances and perspectives. Curr Opin Anaesthesiol, 2020, 33(5): 651-654.
33. Best LM, Webb AC, Gurusamy KS, et al. Transcranial Doppler ultrasound detection of microemboli as a predictor of cerebral events in patients with symptomatic and asymptomatic carotid disease: a systematic review and meta-analysis. Eur J Vasc Endovasc Surg, 2016, 52(5): 565-580.
34. Gaunt ME, Martin PJ, Smith JL, et al. Clinical relevance of intraoperative embolization detected by transcranial Doppler ultrasonography during carotid endarterectomy: a prospective study of 100 patients. Br J Surg, 1994, 81(10): 1435-1439.
35. Warner DS. Anesthetics provide limited but real protection against acute brain injury. J Neurosurg Anesthesiol, 2004, 16(4): 303-307.
36. Bernardi MH, Wahrmann M, Dworschak M, et al. Carotid artery blood flow velocities during open-heart surgery and its association with delirium: a prospective, observational pilot study. Medicine (Baltimore), 2019, 98(50): e18234.
37. 玉红, 梁鹏, 余海, 等. 围术期超声—新时代麻醉科医师的基本技能. 临床麻醉学杂志, 2018, 34(8): 824-826.
38. Han SJ, Rutledge WC, Englot DJ, et al. The presto 1000: a novel automated transcranial Doppler ultrasound system. J Clin Neurosci, 2015, 22(11): 1771-1775.

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Application of transcranial Doppler monitoring cerebral blood flow in operation with anesthesia

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