Ghent University Academic Bibliography

Advanced

Value of Cushing reflex as warning sign for brain ischaemia during neuroendoscopy

Alain Kalmar, Jozef Van Aken, Jacques Caemaert, Eric Mortier UGent and Michel Struys UGent (2005) BRITISH JOURNAL OF ANAESTHESIA. 94(6). p.791-799
abstract
Background. During an endoscopic neurosurgical procedure a sudden increase in intracranial pressure may occur at any time. We present a prospective study of haemodynamic changes during such procedures. Methods. Physiological data were recorded during the whole operative procedure in 17 consecutive patients who underwent an endoscopic neurosurgical procedure under general anaesthesia. Monitoring included invasive blood pressure, intracranial pressure, electrocardiogram, end-expired carbon dioxide, pulse oximetry and heart rate. Pressure and ECG waveforms were recorded at 100 Hz and evaluated in a subsequent offline analysis. Results. In almost every case, the occurrence of hypertension and tachycardia was clearly the result of an increase in intracranial pressure. Also, a Cushing reflex developed in almost every case where the cerebral perfusion pressure dropped below 15 mm Hg. The occurrence of bradycardia was not systematically associated with a low cerebral perfusion pressure. Conclusion. In this study, we describe the haemodynamic effects of increased intracranial pressure during endoscopic neurosurgical procedures and their respective sequence of events at high temporal resolution. Although most clinicians rely on the occurrence of bradycardia to diagnose intracranial hypertension during endoscopic neurosurgical procedures, we show that a simultaneous onset of hypertension and tachycardia is a better indicator of impaired brain perfusion. Waiting for a persistent bradycardia to alert the surgeon during endoscopic neurosurgical procedures could allow severe bradycardia or even asystole to develop.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
journal title
BRITISH JOURNAL OF ANAESTHESIA
Br. J. Anaesth.
volume
94
issue
6
pages
791 - 799
Web of Science type
Article
Web of Science id
000228930700017
JCR category
ANESTHESIOLOGY
JCR impact factor
2.425 (2005)
JCR rank
8/22 (2005)
JCR quartile
2 (2005)
ISSN
0007-0912
DOI
10.1093/bja/aei121
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
312423
handle
http://hdl.handle.net/1854/LU-312423
date created
2005-06-09 14:46:00
date last changed
2016-12-19 15:42:53
@article{312423,
  abstract     = {Background. During an endoscopic neurosurgical procedure a sudden increase in intracranial pressure may occur at any time. We present a prospective study of haemodynamic changes during such procedures. 
Methods. Physiological data were recorded during the whole operative procedure in 17 consecutive patients who underwent an endoscopic neurosurgical procedure under general anaesthesia. Monitoring included invasive blood pressure, intracranial pressure, electrocardiogram, end-expired carbon dioxide, pulse oximetry and heart rate. Pressure and ECG waveforms were recorded at 100 Hz and evaluated in a subsequent offline analysis. 
Results. In almost every case, the occurrence of hypertension and tachycardia was clearly the result of an increase in intracranial pressure. Also, a Cushing reflex developed in almost every case where the cerebral perfusion pressure dropped below 15 mm Hg. The occurrence of bradycardia was not systematically associated with a low cerebral perfusion pressure. 
Conclusion. In this study, we describe the haemodynamic effects of increased intracranial pressure during endoscopic neurosurgical procedures and their respective sequence of events at high temporal resolution. Although most clinicians rely on the occurrence of bradycardia to diagnose intracranial hypertension during endoscopic neurosurgical procedures, we show that a simultaneous onset of hypertension and tachycardia is a better indicator of impaired brain perfusion. Waiting for a persistent bradycardia to alert the surgeon during endoscopic neurosurgical procedures could allow severe bradycardia or even asystole to develop.},
  author       = {Kalmar, Alain and Van Aken, Jozef and Caemaert, Jacques and Mortier, Eric and Struys, Michel},
  issn         = {0007-0912},
  journal      = {BRITISH JOURNAL OF ANAESTHESIA},
  language     = {eng},
  number       = {6},
  pages        = {791--799},
  title        = {Value of Cushing reflex as warning sign for brain ischaemia during neuroendoscopy},
  url          = {http://dx.doi.org/10.1093/bja/aei121},
  volume       = {94},
  year         = {2005},
}

Chicago
Kalmar, Alain, Jozef Van Aken, Jacques Caemaert, Eric Mortier, and Michel Struys. 2005. “Value of Cushing Reflex as Warning Sign for Brain Ischaemia During Neuroendoscopy.” British Journal of Anaesthesia 94 (6): 791–799.
APA
Kalmar, Alain, Van Aken, J., Caemaert, J., Mortier, E., & Struys, M. (2005). Value of Cushing reflex as warning sign for brain ischaemia during neuroendoscopy. BRITISH JOURNAL OF ANAESTHESIA, 94(6), 791–799.
Vancouver
1.
Kalmar A, Van Aken J, Caemaert J, Mortier E, Struys M. Value of Cushing reflex as warning sign for brain ischaemia during neuroendoscopy. BRITISH JOURNAL OF ANAESTHESIA. 2005;94(6):791–9.
MLA
Kalmar, Alain, Jozef Van Aken, Jacques Caemaert, et al. “Value of Cushing Reflex as Warning Sign for Brain Ischaemia During Neuroendoscopy.” BRITISH JOURNAL OF ANAESTHESIA 94.6 (2005): 791–799. Print.