Back to contents
«Messenger of Anesthesiology and Resuscitation» Vol 14, №6, 2017,

DOI : 10.21292/2078-5658-2017-14-6-44-51

Impact of anesthesia methods on central hemodynamics and cerebral blood flow during carotid endarterectomy

M. I. NEYMАRK 1 , V. V. SHMELEV 1 , А. А. SHАYDUROV 2 , B. А. SHАDYMOV 3

  • 1 Departmental Clinical Hospital at the Railroad Station of Barnaul, OAO RZD, Barnaul, Russia
  • 2 Altai State University, Barnaul, Russia
  • 3 Altai Regional Cardiac Dispensary, Barnaul, Russia

The objective: to compare the impact of two methods of general anesthesia during carotid endarterectomy on central hemodynamics and cerebral blood flow in order to choose the best anaesthesiologic tactics.
Materials and subjects. The total intravenous anesthesia (sedation with propofol, n = 60) and general combined anesthesia (sedation with sevoflurane, n = 60) were compared in 130 patients undergoing carotid endarterectomy. Parameters of central hemodynamics and cerebral blood circulation were investigated.
Results. It was found out that anesthesia with sevoflurane supported an effective level of central hemodynamics and provided a higher level of cerebral blood flow and was associated with statistically significant (11.9%) reduction in the number of neurological complications versus anesthesia with propofol.
Conclusion: Inhalation anesthesia with sevoflurane can be considered the choice of anesthesia in carotid endarterectomy.

Key Words: carotid endarterectomy,central hemodynamics, cerebral blood flow, atherosclerosis, carotid, surgery, atherosclerosis plaque

References

  • 1.Аbramov I.S., Maytesyan D.А., Kirsanov Yu.K. et al. Impact of carotid endarterectomy on the changes in cognitive disorders in the patients with carotid atherosclerosis (literature review). Kardiologiya i Serdechno-Sosudistaya Khirurgiya, 2010, vol. 3, no. 5, pp. 46-52. (In Russ.)
  • 2.Аkhmadeeva L.R., Plechev V.V., Bikbulatova L.F. et al. Potential complications in the nervous system during carotid endarterectomy: causes and methods of prevention. Uralsky Meditsinsky Journal, 2012, no. 5, pp. 58-62. (In Russ.)
  • 3.Аkhmedov А.D., Usachev D.Yu., Lukshin V.А. et al. Carotid endarterectomy in the patients with a high surgical risk. Voprosy Neyrokhirurgii Im. N. N. Burdenko, 2013, vol. 77, no. 4, pp. 36-42. (In Russ.)
  • 4.Vyortkin А.L., Khamitov F.F., Mayboroda E.L. et al. The first experience of comparative treatment efficiency of hypertensive crisis in the post-operative period after carotid endarterectomy. Kardiovaskulyarnaya Terapiya i Profilaktika, 2011, vol. 10, no. 6, pp. 18-23. (In Russ.)
  • 5.Vinogradov V.L., Larionov I.Yu. The case of transient complete suppression of cerebral electrical activity during anesthesia with propofol. Anesteziologiya i Reanimatologiya, 2009, no. 3, pp. 71-73. (In Russ.)
  • 6.Gavrilenko А.V., Kravchenko А.А., Kuklin А.V. Carotid endarterectomy in the patients after ischemic stroke. Kardiologiya i Serdechno-Sosudistaya Khirurgiya, 2017, vol. 10, no. 2, pp. 62-69. (In Russ.)
  • 7.Geraskina L.А. Khronicheskie tserebrovaskulyarnye zabolevaniya pri arterialnoy gipertonii: krovosnabzhenie mozga, tsentralnaya gemodinamika i funktsionalny sosudisty rezerv. Diss. dokt. med. nauk. [Chronic cerebral vascular disorders in arterial hypertension: cerebral circulation, central hemodynamics and functional vascular reserve. Doct. Diss.]. Nauchny Tsentr Nevrologii Publ., Moscow, 2008.
  • 8.Ivshin А.А., Gumenyuk E.G., Shifman E.M. Diagnostics of disorders of cerebral arterial hemodynamics in the pregnant with severe preeclampsia. Ros. Vestn. Akushera-Ginekologa, 2005, no. 1, pp. 4-8. (In Russ.)
  • 9.Ignatiev I.M., Bredikhin R.А., Falina T.G. et al. Monitoring of cerebral hemodynamics in surgeries on brachicephalic arteries. Аngiologiya i Sosudistaya Khirurgiya, 2010, vol. 16, no. 3, pp. 107-112. (In Russ.)
  • 10.Karpenko А.А., Levicheva E.N., Starodubtsev V.B. et al. Oxygen cerebral supply during carotid endarterectomy using local and general anesthesia. Аngiologiya i Sosudistaya Khirurgiya, 2011, vol. 17, no. 2, pp. 101-106. (In Russ.)
  • 11.Karpenko А.А., Levicheva E.N., Starodubtsev V.B. et al. Evaluation of brain protection by cerebral oxymetry in carotid endarterectomy. Аngiologiya i Sosudistaya Khirurgiya, 2011, vol. 17, no. 1, pp. 113-117. (In Russ.)
  • 12.Klypa T.V., Eremenko А.А., Shepelyuk А.N. et al. Opportunities of pharmacological neuroprotection in cardiac-surgical patients (Part 1). Medications for general anesthesia. Anesteziologiya i Reanimatologiya, 2015, vol. 60, no. 4, pp. 43-49. (In Russ.)
  • 13.Kraynik V.M., Kozlov S.P., Deshko Yu.V., Kuklin А.V. et al. Comparative characteristics of option of general and combined anesthesia in surgeries of internal carotid artery. Anesteziologiya i Reanimatologiya, 2011, no. 6, pp. 20-24. (In Russ.)
  • 14.Kuntsevich G.I., Tanashyan M.M., Skrylev S.I. et al. Intra-operative monitoring of cerebral blood flow and state of brain matter in open and endovascular surgeries on the carotid system. Аngiologiya i Sosudistaya Khirurgiya, 2011, vol. 17, no. 3, pp. 43-48. (In Russ.)
  • 15.Kucherenko S.S. Carotid surgery: current state of the problem (literature review). Vestnik Rossiyskogo Gosudarstvennogo Meditsinskogo Universiteta, 2011, no. 4, pp. 16-20. (In Russ.)
  • 16.Larionov M.V., Trubnikova O.А., Plotnikov G.P. et al. Rationale for the choice of anesthetics in order to provide cerebral protection and prevent cognitive decline during coronary artery bypass graft. Meditsina v Kuzbasse, 2015, no. 3, pp. 43-51. (In Russ.)
  • 17.Lebedinets V.V., Pesotskaya E.V., Karpovich D.I. et al. Carotid endarterectomy as a stage of prevention of atherothrombotic stroke. Meditsina Transporta Ukrainy, 2009, no. 4 (32), pp. 65-68. (In Russ.)
  • 18.Malchenko A.L. Optimisation of anti-ischemic cerebral protection during surgeries on extracranial arteries. Patologiya Krovoobrascheniya i Kardiokhirurgiya, 2011, no. 3, pp. 57-62. (In Russ.)
  • 19.Neymark M.I., Shmelyov V.V., Merkulov I.V. et al. Parameters of the cerebral blood flow, markers of cerebral lesions when using various types of anesthesia during reconstructive surgeries on carotid. Meditsina v Kuzbasse, 2011, no. 2, pp. 16-21. (In Russ.)
  • 20.Neymark M.I., Shmelyov V.V., Simagin V.Yu. et al. Choice of anesthesia, neuro-protective therapy in reconstructive surgery of extracranial arteries. Obschaya Reanimatologiya, 2011, vol. VII, no. 5, pp. 22-27. (In Russ.)
  • 21.Oborin A.A. The role of cerebro-vascular hemodynamics in the course of resistant arterial hypertension. Carotid endarterectomy as a method of its management. Nauchnoe soobschestvo studentov − sbornik materialov XIV Mezhdunarodnoy studencheskoy nauchno-prakticheskoy konferentsii. [Research Students' Society. Abst. book of the XIVth International Students' Scientific Practical Conference]. 2017, pp. 55-58. (In Russ.)
  • 22.Parfenov V.А., Verbitskaya S.V. Prevention of stroke in case of atherosclerotic carotid stenosis. Klinicheskaya Gerontologiya, 2011. vol. 17, no. 7-8, pp. 3-9. (In Russ.)
  • 23.Pechenkin А.А., Lyzikov А.А. Carotid endarterectomy: outcomes and perspectives. Novosti Khirurgii. 2014, vol. 22, no. 2, pp. 231-238. (In Russ.)
  • 24.Pokrovsky A.V. Prevention of ischemic stroke: surgery of main cerebral arteries. Trudy I Natsionalnogo Kongressa «Kardionevrologiya». [Abst. book of the Ith National Congress on Cardiac Neurology]. Moscow, 2008, pp. 27-30. (In Russ.)
  • 25.Pokrovskiy А.V., Gontarenko V.N. Sostoyanie sosudistoy khirurgii v Rossii v 2013 godu. [State of vascular surgery in Russia in 2013]. Rossiyskoe Obschestvo Angiologov i Sosudistykh Khirurgov Publ. 2013, pp. 26-27.
  • 26.Polushin Yu.S., Schegolev A.V. Protection of brain from ischemia: state of the problem. Anesteziologiya i Reanimatologiya, 2005, no. 4, pp. 4-14. (In Russ.)
  • 27.Simagin V.Yu. Аnesteziya sevoflyuranom pri rekonstruktivnykh operatsiyakh na sonnykh arteriyakh. Diss. kand. med. nauk. [Anesthesia with sevoflurane in reconstructive carotid surgery. Cand. Diss.]. Altai State Medical University Publ., Barnaul, 2011.
  • 28.Tanashyan M.M., Lagoda O.V., Domashenko M.А. Prevention of ischemic strokes in the patients with atherosclerotic pathology of main cerebral arteries. Atmosphera. Nervnye Bolezni, 2008, no. 1, pp. 2-6. (In Russ.)
  • 29.Unzhakov V.V., Sukhotin S.K. Impact of various methods of sedation on lipid peroxygenation in the patients with severe cerebral injury. Obschaya Reanimatologiya, 2008, vol. IV, no. 5, pp. 10-13. (In Russ.)
  • 30.Fedin А.I., Kuznetsov M.R., Beresten N.F. et al. Autoregulation of cerebral blood flow. Journal Nevrologii i Psikhiatrii im. S.S. Korsakova, 2011, vol. 111, no. 1, pp. 68-73. (In Russ.)
  • 31.Fokin А.А., Borsuk D.А. Specific features of carotid surgeries in type 2 diabetes patients: multi-centered inquiry. Kardiologiya i Serdechno-Sosudistaya Khirurgiya, 2011, vol. 4, no. 4, pp. 58-60. (In Russ.)
  • 32.Khatagova D.T., Pyshkina L.I., Darvish N.А. et al. Carotid endarterectomy as a method of ischemic stroke prevention. Byulleten NTSSSKH Im. А.N. Bakuleva RАMN Serdechno-Sosudistye Zabolevaniya, 2014, vol. 15, no. S6, pp. 139. (In Russ.)
  • 33.Khatinskiy А.S., Fursov А.А., Bigashev R.B. Use of sevoflurane during cardiopulmonary bypass under normothermia. Sibirskoye Meditsinskoye Obozreniye, 2010, no. 2 (62), pp. 81-84. (In Russ.)
  • 34.Shifman E.M., Gumenyuk E.G., Ivshin А.А. Diagnostics of cerebral lesions in the pregnant with preeclampsia and eclampsia. Аkusherstvo i Ginekologiya, 2004, no. 6, pp. 6-8. (In Russ.)
  • 35.Shmelyov V.V., Kukhlenko А.V., Khaustova S.А. Monitoring of changes in cerebral competences in various types of anesthesia during reconstructive carotid surgery for atherosclerotic occlusion. Aspirant, 2016, no. 3 (19), pp. 25-29. (In Russ.)
  • 36.Schurov V.А., Novikov K.I., Shigarev V.M. Blood flow velocity through medial cerebral arteries in case of disorders and traumas of extremities. Mezhdunarodny Journal Prikladnykh i Fundamentalnykh Issledovaniy, 2015, no. 1-2, pp. 73-77. (In Russ.)
  • 37.Schurov V.A. Blood flow velocity through medial cerebral arteries and human efficiency. Mezhdunarodny Journal Prikladnykh i Fundamentalnykh Issledovaniy, 2016, no. 5 (2), pp. 255-258. (In Russ.)
  • 38.Belfort M.A., Varner M.W., Dizon-Townson D.S. et al. Cerebral perfusion pressure, and not cerebral blood flow, may be the critical determinant of intracranial injury in preeclampsia: a new hypothesis. Am. J. Obstet Gynecol., 2002, vol. 187, pp. 626-634.
  • 39.Chida K., Ogasawara K., Suga Y. et al. Post-operative death of neurons of the cerebral cortex is associated with cerebral hyperperfusion and causes the development of cognitive disorders after carotid endarterectomy. Journal Natsionalnoy Assotsiatsii po Borbe s Insultom, Stroke, Russian Issue, 2009, no. 2-3, pp. 76-82. (In Russ.)

For citation: Neymark M. I., Shmelev V. V., Shaydurov А. А., Shadymov B. А. Impact of anesthesia methods on central hemodynamics and cerebral blood flow during carotid endarterectomy «Messenger of Anesthesiology and Resuscitation» 2017; 14(6):44-51. DOI : 10.21292/2078-5658-2017-14-6-44-51


For citation: Neymark M. I., Shmelev V. V., Shaydurov А. А., Shadymov B. А. Impact of anesthesia methods on central hemodynamics and cerebral blood flow during carotid endarterectomy «Messenger of Anesthesiology and Resuscitation» 2017; 14(6):44-51. DOI : 10.21292/2078-5658-2017-14-6-44-51

Для доступа нужна подписка. Войдите в систему для подтверждения ее наличия.