The role of blood pressure versus oxygen administration on cerebral oxygenation during and after anaesthesia induction: A prospective cohort study.

IF 6.8 2区医学 Q1 ANESTHESIOLOGY

European Journal of Anaesthesiology Pub Date : 2025-08-07 DOI:10.1097/EJA.0000000000002245

Yu K Lam, Rogier V Immink, Jimmy Schenk, Rokus E C van den Dool, Markus W Hollmann, Denise P Veelo, Alexander P J Vlaar, Johan T M Tol, Ward H van der Ven, Lotte E Terwindt, Eline Kho

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引用次数: 0

Abstract

Background: The effect of anaesthesia induction on cerebral perfusion is complex due to the coinciding respiratory and haemodynamic changes that occur.

Objective: To examine how changes in blood pressure and oxygen administration are related to cerebral oxygenation and its progression over time during and after anaesthesia induction.

Design: Prospective observational study.

Setting: Dutch tertiary hospital from October 2019 to May 2022.

Patients: Two hundred and fifty-one elective cardiac surgery patients of which 188 were included in the analysis.

Main outcome measures: Continuous cerebral oxygenation, measured using near-infrared spectroscopy (NIRS)-based regional cerebral tissue oximetry, was assessed in relation to mean arterial pressure (MAP), partial pressure of end-tidal oxygen (PetO 2 ) and fraction of inspired oxygen (FiO 2 ) during and after anaesthesia induction. Cerebral oxygenation between subgroups with and without the occurrence of postinduction hypotension (PIH) (defined as a MAP <65 mmHg for >60 s) was compared. PetO 2 was used as a measure for the efficacy of oxygen administration to assess the effect of a high FiO 2 of 1.0 on cerebral oxygenation.

Results: Cerebral oxygenation and PetO 2 increased during anaesthesia induction with the use of a FiO 2 of 1.0, while blood pressure decreased. All parameters decreased after anaesthesia induction, but the timing of onset of decline in cerebral oxygenation coincided with the moment that the FiO 2 was adjusted from high to low, whereas it preceded the decline in MAP by 16.4 s (95% confidence interval (CI), 2.4 to 30.4; P = 0.02). The occurrence of PIH, which comprised of 42% of our study population, did not affect cerebral oxygenation. During anaesthesia induction and the use of a FiO 2 of 1.0, cerebral oxygenation increased by 0.14% (95% CI, 0.12 to 0.16; P < 0.001) per percentage point increase in PetO 2 .

Conclusion: Changes in regional cerebral tissue oximetry during and after anaesthesia induction are more related to changes in oxygen administration than blood pressure.

Trial registration: Overview of medical research in the Netherlands (reference: NL-OMON29121).

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在麻醉诱导期间和之后，血压和给氧对脑氧合的作用：一项前瞻性队列研究。

背景：麻醉诱导对脑灌注的影响是复杂的，因为同时发生呼吸和血流动力学的变化。目的：探讨麻醉诱导期间和麻醉诱导后血压和给氧量的变化与脑氧合及其进展的关系。设计：前瞻性观察研究。地点：荷兰三级医院，2019年10月至2022年5月。患者：251例选择性心脏手术患者，其中188例纳入分析。主要观察指标：使用基于近红外光谱（NIRS）的区域脑组织血氧仪测量持续脑氧合，评估麻醉诱导期间和之后平均动脉压（MAP）、潮末氧分压（PetO2）和吸入氧分数（FiO2）的关系。比较有和没有发生诱导后低血压（PIH）（定义为MAP 60 s）的亚组之间的脑氧合情况。以PetO2作为给氧效果指标，评价高FiO2 1.0对脑氧合的影响。结果：FiO2 1.0麻醉诱导时脑氧合和PetO2升高，血压下降。麻醉诱导后各参数均下降，但脑氧合下降的发生时间与FiO2由高到低调整的时刻一致，而MAP下降时间比其早16.4 s(95%可信区间（CI）， 2.4 ~ 30.4；p = 0.02)。PIH的发生，占我们研究人群的42%，不影响脑氧合。在麻醉诱导和使用FiO2为1.0时，脑氧合增加0.14% (95% CI, 0.12 ~ 0.16；结论：麻醉诱导时及麻醉诱导后脑组织局部氧饱和度变化与给氧变化的关系大于与血压变化的关系。试验注册：荷兰医学研究概况（参考：NL-OMON29121）。

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来源期刊

European Journal of Anaesthesiology 医学-麻醉学

CiteScore

6.90

自引率

11.10%

发文量

351

审稿时长

6-12 weeks

期刊介绍： The European Journal of Anaesthesiology (EJA) publishes original work of high scientific quality in the field of anaesthesiology, pain, emergency medicine and intensive care. Preference is given to experimental work or clinical observation in man, and to laboratory work of clinical relevance. The journal also publishes commissioned reviews by an authority, editorials, invited commentaries, special articles, pro and con debates, and short reports (correspondences, case reports, short reports of clinical studies).