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Anesthesia Medication Effects on Cerebral Hemodynamics

Anesthesia Medication Effects on Cerebral Hemodynamics. INCREASE. DECREASE. Site of autoregulation. Site of autoregulation Site of medication effects. Site of autoregulation Site of medication effects. D ifficult to measure. Site of autoregulation Site of medication effects.

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Anesthesia Medication Effects on Cerebral Hemodynamics

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  1. Anesthesia Medication Effects on Cerebral Hemodynamics

  2. INCREASE DECREASE

  3. Site of autoregulation

  4. Site of autoregulation • Site of medication effects

  5. Site of autoregulation • Site of medication effects Difficult to measure

  6. Site of autoregulation • Site of medication effects Difficult to measure Varies to a lesser degree than CBF

  7. CBF Autoregulation

  8. CBF Autoregulation

  9. Site of autoregulation • Site of medication effects Difficult to measure Varies to a lesser degree than CBF Brain Tissue, CSF, CBV

  10. Site of autoregulation • Site of medication effects Difficult to measure Varies to a lesser degree than CBF Brain Tissue, CSF, CBV Focal vs global Affects all variables

  11. (MAP-ICP)= CPP _____________ Resistance

  12. MAP- ICP Directly Proportional _____________ Resistance

  13. MAP- ICP Directly Proportional _____________ Resistance Inversely proportional

  14. MAP- ICP Metabolism _____________(CMRO2) Resistance

  15. Normal Values:

  16. Normal Values: 15-20% of CO

  17. Normal Values: 15-20% of CO 750 mL/min

  18. Normal Values: 15-20% of CO 750 mL/min 50 mL/100g/min

  19. Questions

  20. Question #1 • In the normal patient, what is the largest component of the cranial vault? • A. Brain Tissue • B. CSF • C. CBV • D. MAP

  21. Answer • Question #1: A) Brain Tissue • The 3 components that make up the cranial vault are brain tissue, CSF, and CBV. Brain tissue accounts for 80% of the space while CSF and CBV account for 10% each. However, when ICP is altered it is typically caused by a change in CBV.

  22. Question #2 • Which of the following parameters is true for the normal patient? • A. 35% of cardiac output to the brain • B. Blood flow of 50 ml/min/100 g of brain tissue • C. ICP of 17 mmHg • D. Both A and B

  23. Answer • Question #2: B) Blood flow of 50 ml/min/100 g of brain tissue • Normal ICP is <15 and the brain normally receives 15-20% of cardiac output. The typical blood flow to the brain is 750 ml/min or 50 ml/min/100 g of tissue. Cerebral Ischemia begins when blood flow drops below 20 ml/min/100 g and infarct begins at 6 ml/min/100 g of tissue.

  24. Question #3 • All of the following increase CBF, except: • A. Hypercarbia • B. Hypoxia • C. Increased cerebral vascular resistance • D. They all increase CBF

  25. Answer • Question #3: C) Increased cerebral vascular resistance • Both hypercarbia and hypoxia increase CBF. Hypoxia increases CBF by causing an increased metabolic demand. Hypercarbia has a direct vasodilatory effect on the cerebral vasculature. Increased cerebral vascular resistance would decrease CBF.

  26. MAP 60-150

  27. MAP 60-150 Rapid change will still affect CBF

  28. MAP 60-150 Rapid change will still affect CBF Disrupted by : volatile anesthetics

  29. MAP 60-150 Rapid change will still affect CBF Disrupted by : volatile anesthetics HTN

  30. Pt’s Baseline MAPis the best indicator of their autoregulationrange

  31. CBF Autoregulation

  32. CBF Autoregulation

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