Title: Application of transcranial Doppler to guide regulation of cerebral blood flow during carotid endarterectomy
Abstract: Objective To analyze the value of transcranial Doppler ultrasonography(TCD) retrospectively for perioperative management of carotid endarterectomy.Method Carotid endarterectomy was performed in 52 patients with severe carotid stenosis under general anesthesia.The blood flow parameters of middle cerebral artery(MCA) were detected by TCD during the operation.The blood pressure was regulated,and whether need a temporary vascular shunt or not was determined according to the changes of cerebral blood flow parameters.Sixteen patients(shunt group) used temporary vascular shunts and 36 patients(nonshunt group) did not.Results ①Fifty-two patients recovered completely after the operation,50 of them had no brain ischemic attack,and 2 patients died of cerebral hemorrhage due to hyperperfusion.②The mean arterial pressures(MAPs) in the shunt group or non shunt group before carotid artery occlusion were 111±9 and 97±15 mm Hg respectively,and there were statistically significant differences between the two groups.The mean flow velocities of MCA(MCA Vm) were 40±12 and 39±13 cm/s respectively,and there were no statistically significant differences between the two groups.③The MAPs were 118±8 and 106±9mm Hg in the two groups after occlusion,and there were statistically significant differences as compared with those before the occlusion.The MCA Vm were 14±8 and 33±16 cm/s,and they decreased 66±6% and 15±5% respectively as compared with those before the occlusion.④The MAP was 110±13 mm Hg during the bypass in the shunt group,and it was near the level before occlusion,the MCA Vm was 44±15 cm/s,it increased 10±2% as compared with that before the occlusion.⑤the MAPs were 90±12 and 93±11 mm Hg in the two groups after opening of the carotid artery;The MCA Vm were 55±19 and 54±23,they increased 36±3% and 37±4% as compared with those before carotid artery occlusion,and there were statistically significant differences.Conclusion The application of TCD monitoring in perioperative management can evaluate cerebral blood flow perfusion,guiding the regulation of blood pressure and selection of vascular shunt during the operation.
Publication Year: 2008
Publication Date: 2008-01-01
Language: en
Type: article
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