(Stroke. 1995;26:1014-1019.)
© 1995 American Heart Association, Inc.
Articles |
Comparison of Static and Dynamic Cerebral Autoregulation Measurements
From the Departments of Neurological Surgery (F.P.T., A.M.L., R.A., D.W.N.) and Anesthesiology (A.M.L.), University of Washington, Harborview Medical Center (Seattle).
Correspondence to David W. Newell, Harborview Medical Center, 325 Ninth Ave, ZA-86, Seattle, WA 98104.
Background and Purpose Cerebral autoregulation can be evaluated by measuring relative blood flow changes in response to a steady-state change in the blood pressure (static method) or during the response to a rapid change in blood pressure (dynamic method). The purpose of this study was to compare the results of the two methods in humans with both intact and impaired autoregulatory capacity.
Methods Using intraoperative transcranial Doppler sonography recordings from both middle cerebral arteries, we determined static and dynamic autoregulatory responses in 10 normal subjects undergoing elective surgical procedures. The changes in cerebrovascular resistance were estimated from the changes in cerebral blood flow velocity and arterial blood pressure in response to manipulations of blood pressure. Static autoregulation was determined by analyzing the response to a phenylephrine-induced rise in blood pressure, whereas rapid deflation of a blood pressure cuff around one thigh served as a stimulus for testing dynamic autoregulation. Both measurements were performed in patients with intact autoregulation during propofol anesthesia and again in the same patients after autoregulation had been impaired by administration of high-dose isoflurane.
Results There was a significant reduction in autoregulatory capacity after the administration of high-dose isoflurane, which could be demonstrated using static (P<.0001) and dynamic (P<.0001) methods. The correlation between static or steady-state and dynamic autoregulation measurements was highly significant (r=.93, P<.0001).
Conclusions These data show that in normal human subjects measurement of dynamic autoregulation yields similar results as static testing of intact and pharmacologically impaired autoregulation.
Key Words: autoregulation • blood flow velocity • cerebral blood flow • ultrasonics
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R. B. Panerai, R. P. White, H. S. Markus, and D. H. Evans Grading of Cerebral Dynamic Autoregulation From Spontaneous Fluctuations in Arterial Blood Pressure Stroke, November 1, 1998; 29(11): 2341 - 2346. [Abstract] [Full Text] [PDF]
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E. M. Manno, D. R. Gress, L. H. Schwamm, M. N. Diringer, and C. S. Ogilvy Effects of Induced Hypertension on Transcranial Doppler Ultrasound Velocities in Patients After Subarachnoid Hemorrhage Stroke, February 1, 1998; 29(2): 422 - 428. [Abstract] [Full Text] [PDF]
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R. Zhang, J. H. Zuckerman, C. A. Giller, and B. D. Levine Transfer function analysis of dynamic cerebral autoregulation in humans Am J Physiol Heart Circ Physiol, January 1, 1998; 274(1): H233 - H241. [Abstract] [Full Text] [PDF]
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A. P. Blaber, R. L. Bondar, F. Stein, P. T. Dunphy, P. Moradshahi, M. S. Kassam, and R. Freeman Transfer Function Analysis of Cerebral Autoregulation Dynamics in Autonomic Failure Patients Stroke, September 1, 1997; 28(9): 1686 - 1692. [Abstract] [Full Text]
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R. Schondorf, J. Benoit, and T. Wein Cerebrovascular and Cardiovascular Measurements During Neurally Mediated Syncope Induced by Head-Up Tilt Stroke, August 1, 1997; 28(8): 1564 - 1568. [Abstract] [Full Text]
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R. P. White and H. S. Markus Impaired Dynamic Cerebral Autoregulation in Carotid Artery Stenosis Stroke, July 1, 1997; 28(7): 1340 - 1344. [Abstract] [Full Text]
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S. Cencetti, G. Bandinelli, and A. Lagi Effect of Pco2 Changes Induced by Head-Upright Tilt on Transcranial Doppler Recordings Stroke, June 1, 1997; 28(6): 1195 - 1197. [Abstract] [Full Text]
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P. Smielewski, M. Czosnyka, P. Kirkpatrick, H. McEroy, H. Rutkowska, and J. D. Pickard Assessment of Cerebral Autoregulation Using Carotid Artery Compression Stroke, December 1, 1996; 27(12): 2197 - 2203. [Abstract] [Full Text]
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F. P. Tiecks, C. Douville, S. Byrd, A. M. Lam, and D. W. Newell Evaluation of Impaired Cerebral Autoregulation by the Valsalva Maneuver Stroke, July 1, 1996; 27(7): 1177 - 1182. [Abstract] [Full Text]
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