Titel: Optimal mean arterial pressure based on cerebrovascular autoregulation during and after non-cardiac surgery
Sprache: Englisch
Autor*in: Yang, Yi
Erscheinungsdatum: 2023
Tag der mündlichen Prüfung: 2023-06-06
Background: Cerebrovascular autoregulation (CVA) maintains steady cerebral brain blood flow despite changes in perfusion pressure, a mechanism which is crucial during surgery and anaesthesia. Perioperative measurement of CVA allows for the determination of CVA-based optimal mean arterial blood pressure (MAPopt), which is defined as the blood pressure at which the CVA reaches maximal activity. The aim of this study was to compare intra- and postoperative CVA-based MAPopt and time-weighted average (TWA)-MAP below the CVA-based MAPopt. In addition, this study aimed to assess factors associated with intra- and postoperative TWA-MAP below the CVA-based MAPopt.
Methods: This sub-study of an ongoing single-centre prospective cohort study was conducted between August 2021 and May 2022. Adult patients scheduled for non-cardiac surgery of >120 minutes with general anaesthesia, invasive blood pressure monitoring and pre-existing anaemia or expected blood loss >500ml were enrolled. CVA was assessed through correlation between MAP and regional cerebral oxygen saturation detected by near-infrared spectroscopy. Each patient was assessed intra- and postoperatively. CVA-based MAPopt was defined as MAP with the lowest correlation with cerebral oxygen saturation . TWA-MAP was calculated as the area between the MAP and the MAPopt curve, normalized to the duration of CVA assessment. Factors associated with the intra- and postoperative TWA-MAP below the CVA-based MAPopt were analysed using multivariable general linear models.
Results: The final analysis included 161 patients. The median intra- and postoperative CVA-based MAPopt differed significantly (77.85 (IQR: 72.78, 84.13) mmHg versus 85.10 (IQR: 77.91, 95.06) mmHg, p < 0.001). The median intra- and postoperative TWA-MAP below the CVA-based MAPopt did not differ significantly (2.59 (IQR: 0.93, 5.41) mmHg versus 4.26 (IQR: 1.06, 8.73) mmHg, p = 0.118). Propofol for anaesthesia maintenance was associated with a larger intraoperative TWA-MAP below the CVA-based MAPopt.
Conclusion: Intraoperative CVA-based MAPopt is lower than postoperative CVA-based MAPopt, which might require different blood pressure management in different perioperative periods. The application of propofol for anaesthesia maintenance and major abdominal surgery are associated with lower intraoperative MAP.
URL: https://ediss.sub.uni-hamburg.de/handle/ediss/10422
URN: urn:nbn:de:gbv:18-ediss-111379
Dokumenttyp: Dissertation
Betreuer*in: Fischer, Marlene
Enthalten in den Sammlungen:Elektronische Dissertationen und Habilitationen

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