Crossref journal-article
Journal of Neurosurgery Publishing Group (JNSPG)
Journal of Neurosurgery (1754)
Abstract

✓ A study of 21 patients was conducted to clarify the autoregulatory capacity in patients subjected to induced hypotension during intracranial surgery for saccular aneurysms. Trimethaphan camsylate (Arfonad) was used for induced hypotension and arterial blood flow was measured with an electromagnetic flow probe on the internal carotid artery or one of its main intracranial branches. In Grade I and II patients the control arterial blood pressure (ABP) ranged from a mean of 90 to 135 mm Hg (average 110 mm Hg), with a lower level of autoregulation (LLAR) from 35 to 85 mm Hg (average 62 mm Hg). Grade III patients had a control ABP of between 105 and 145 mm Hg (average 124 mm Hg) and the LLAR was found to be between 60 and 95 mm Hg (average 76 mm Hg). There was a significant difference between the two groups with regard to both the control ABP and the LLAR. A surprising result obtained from these data was that the average lower autoregulatory range (the difference between control ABP and LLAR) is practically the same in the two groups. A systematic investigation of the upper limit of autoregulation was not possible for ethical reasons. In those few patients in whom spontaneous increase in the ABP made such observations possible, upper limits up to 150 mm Hg with a total autoregulatory capacity of about 75 mm Hg were observed. In some patients, however, lower limits and corresponding “breakthroughs” of cerebral blood flow were seen, demonstrating that the upper limit of autoregulation is markedly influenced by several factors.

Bibliography

Nornes, H., Knutzen, H. B., & Wikeby, P. (1977). Cerebral arterial blood flow and aneurysm surgery. Journal of Neurosurgery, 47(6), 819–827.

Authors 3
  1. Helge Nornes (first)
  2. Hanna Berit Knutzen (additional)
  3. Per Wikeby (additional)
References 55 Referenced 72
  1. 10.1093/brain/89.2.235 / Brain / The effects of systemic hypotension upon the human brain. Clinical and neuropathological observations in 11 cases. by Adams (1966)
  2. 10.1161/01.CIR.38.4.800 / Circulation / Autoregulation of cerebral blood flow. Studies during drug-induced hypertension in normal subjects and in patients with cerebral/vascular diseases. by Agnoli (1968)
  3. 10.1093/neurosurgery/21.CN_suppl_1.107 / Clin Neurosurg / A technique of anesthesia with induced hypotension for surgical correction of intracranial aneurysms. by Aitken (1974)
  4. 10.1097/00000542-197001000-00013 / Anaesthesiology / Cerebral circulatory response to acute brain disease: Implications for anesthetic practice. by Alexander (1970)
  5. 10.1136/jnnp.25.1.24 / J Neurol Neurosurg Psychiatry / Cerebral complications of hypotensive anaesthesia in a healthy adult. by Brierley (1962)
  6. 10.1093/oxfordjournals.bmb.a069638 / Br Med Bull / The disadvantages of controlled hypotension in surgery. by Davison (1958)
  7. {'key': 'b7', 'series-title': 'The Nervous System.', 'first-page': '287', 'article-title': 'Intracranial aneurysms', 'volume': '12', 'author': 'Drake', 'year': '1975'} / The Nervous System. / Intracranial aneurysms by Drake (1975)
  8. 10.1159/000114457 / Eur Neurol / Cerebral blood flow autoregulation at high arterial pressures and different levels of carbon dioxide tension in dogs. by Ekstrøm-Jodal (1971)
  9. 10.1093/bja/33.2.109 / Br J Anaesth / A report on mortality and morbidity following 9,107 hypotensive anaesthetics. by Enderby (1961)
  10. 10.3171/jns.1976.45.5.0498 / J Neurosurg / Brain energetics and circulatory control after subarachnoid hemorrhage. by Fein (1976)
  11. 10.1136/jnnp.39.10.1014 / J Neurol Neurosurg Psychiatry / Autoregulation of cerebral blood flow during controlled hypotension in baboons. by Fitch (1976)
  12. {'key': 'b12', 'series-title': 'Br J Anaesth', 'first-page': '1123', 'article-title': 'Effect of halothane on the autoregulation of cerebral blood flow in normotensive and chronically hypertensive baboons.', 'volume': '48', 'author': 'Fitch', 'year': '1976'} / Br J Anaesth / Effect of halothane on the autoregulation of cerebral blood flow in normotensive and chronically hypertensive baboons. by Fitch (1976)
  13. 10.1042/cs0410001 / Clin Sci / The haemodynamic consequences of adaptive structural changes of the resistance vessels in hypertension. by Folkow (1971)
  14. {'key': 'b14', 'series-title': 'Exp Brain Res', 'first-page': '61', 'article-title': 'Elimination by hypoxia of cerebral blood flow autoregulation and EEG relationship.', 'volume': '5', 'author': 'Freeman', 'year': '1968'} / Exp Brain Res / Elimination by hypoxia of cerebral blood flow autoregulation and EEG relationship. by Freeman (1968)
  15. 10.3171/jns.1976.44.2.0215 / J Neurosurg / Changes in local cerebral blood flow following profound systemic hypotension. by Gamache (1976)
  16. 10.1001/jama.1946.02870450026007 / JAMA / The control of bleeding during operation by induced hypotension. by Gardner (1946)
  17. 10.1172/JCI105239 / J Clin Invest / Effect of acute increase in intracranial pressure on blood flow in the internal carotid artery of man. by Greenfield (1965)
  18. 10.1136/jnnp.29.5.398 / J Neurol Neurosurg Psychiatry / Autoregulation of cerebral blood flow: influence of the arterial blood pressure on the blood flow through the cerebral cortex. by Harper (1966)
  19. 10.1001/archneur.1972.00490130003001 / Arch Neurol / The influence of sympathetic nervous activity on cerebral blood flow. by Harper (1972)
  20. 10.1016/0022-510X(72)90016-0 / J Neurol Sci / Cerebral hemodynamic and metabolic changes after experimental subarachnoid hemorrhage. by Hashi (1972)
  21. 10.3171/jns.1972.37.1.0036 / J Neurosurg / Regional cerebral blood flow studies in subarachnoid hemorrhage. by Heilbrun (1972)
  22. 10.3171/jns.1973.38.5.0561 / J Neurosurg / Factors disposing to morbidity in surgery of intracranial aneurysms with special regard to deep controlled hypotension. by Hugosson (1973)
  23. 10.3171/jns.1968.28.1.0014 / J Neurosurg / Surgical risk as related to time of intervention in the repair of intracranial aneurysms. by Hunt (1968)
  24. 10.1161/01.RES.39.4.555 / Circ Res / Lower limit of cerebral blood flow autoregulation in experimental renovascular hypertension in the baboon. by Jones (1976)
  25. {'key': 'b25', 'series-title': 'Br J Anaesth', 'first-page': '639', 'article-title': 'The effects of profound hypotension induced with sodium nitroprusside on cerebral blood flow and metabolism in the baboon.', 'volume': '45', 'author': 'Keaney', 'year': '1973'} / Br J Anaesth / The effects of profound hypotension induced with sodium nitroprusside on cerebral blood flow and metabolism in the baboon. by Keaney (1973)
  26. 10.1136/jnnp.36.6.898 / J Neurol Neurosurg Psychiatry / Cerebral circulatory and metabolic effects of hypotension produced by deep halothane anaesthesia. by Keaney (1973)
  27. 10.1212/WNL.15.8.761 / Neurology / Cerebral blood flow with intracranial hypertension. by Langfitt (1965)
  28. {'key': 'b28', 'series-title': 'Circ Res', 'first-page': '201', 'article-title': 'Autoregulation of cerebral blood flow.', 'volume': '15', 'author': 'Lassen', 'year': '1964'} / Circ Res / Autoregulation of cerebral blood flow. by Lassen (1964)
  29. 10.1152/physrev.1959.39.2.183 / Physiol Rev / Cerebral blood flow and oxygen consumption in man. by Lassen (1959)
  30. {'key': 'b30', 'series-title': 'A Basis and Practice of Neuroanaesthesia.', 'first-page': '136', 'article-title': 'The influence of anaesthetic drugs and techniques on intracranial pressure', 'volume': '2', 'author': 'McDowall', 'year': '1975'} / A Basis and Practice of Neuroanaesthesia. / The influence of anaesthetic drugs and techniques on intracranial pressure by McDowall (1975)
  31. {'key': 'b31', 'series-title': 'Recent Advances in Anaesthesia and Analgesia.', 'first-page': '16', 'article-title': 'Neurosurgical anaesthesia and intensive care', 'volume': '12', 'author': 'McDowall', 'year': '1976'} / Recent Advances in Anaesthesia and Analgesia. / Neurosurgical anaesthesia and intensive care by McDowall (1976)
  32. 10.1016/S0079-6123(08)60102-8 / Prog Brain Res / Concepts of cerebral perfusion pressure and vascular compression during intracranial hypertension. by Miller (1972)
  33. 10.1001/archneur.1975.00490490037003 / Arch Neurol / Cerebral vasospasm and ruptured intracranial aneurysm. by Millikan (1975)
  34. 10.1172/JCI102980 / J Clin Invest / Cerebral hemodynamics during controlled hypotension induced by the continuous infusion of ganglionic blocking agents (hexamethonium, Pendiomide and Arfonad). by Moyer (1954)
  35. 10.1093/neurosurgery/22.CN_suppl_1.321 / Clin Neurosurg / Monitoring of patients with intracranial aneurysms. by Nornes (1975)
  36. {'key': 'b36', 'series-title': 'Cerebral Circulation and Metabolism.', 'first-page': '152', 'article-title': 'Pulsatile blood flow pattern in cerebral circulation', 'author': 'Nornes', 'year': '1975'} / Cerebral Circulation and Metabolism. / Pulsatile blood flow pattern in cerebral circulation by Nornes (1975)
  37. 10.3171/jns.1973.39.2.0226 / J Neurosurg / The role of intracranial pressure in the arrest of hemorrhage in patients with ruptured intracranial aneurysm. by Nornes (1973)
  38. 10.3171/jns.1977.47.6.0810 / J Neurosurg / Cerebral arterial blood flow and aneurysm surgery. Part 1: Local arterial flow dynamics. by Nornes (1977)
  39. 10.1136/jnnp.39.3.221 / J Neurol Neurosurg Psychiatry / Changes in CO2 responsiveness and in autoregulation of the cerebral circulation during and after halothane-induced hypotension. by Okuda (1976)
  40. {'key': 'b40', 'article-title': 'Cerebral blood flow: Methods for measurement, regulation, effects of drugs and changes in disease.', 'author': 'Olesen', 'year': '1974'} / Cerebral blood flow: Methods for measurement, regulation, effects of drugs and changes in disease. by Olesen (1974)
  41. {'key': 'b41', 'series-title': 'Monographs of the Physiological Society', 'article-title': 'The Physiology of Cerebral Circulation.', 'volume': '28', 'author': 'Purves', 'year': '1972'} / Monographs of the Physiological Society / The Physiology of Cerebral Circulation. by Purves (1972)
  42. {'key': 'b42', 'series-title': 'Circ Res', 'first-page': '205', 'article-title': 'Autoregulation of canine cerebral blood flow.', 'volume': '15', 'author': 'Rapela', 'year': '1964'} / Circ Res / Autoregulation of canine cerebral blood flow. by Rapela (1964)
  43. {'key': 'b43', 'series-title': 'Circ Res', 'first-page': '11', 'article-title': 'Blood flow in passive vascular beds.', 'volume': '15', 'author': 'Rapela', 'year': '1964'} / Circ Res / Blood flow in passive vascular beds. by Rapela (1964)
  44. {'key': 'b44', 'series-title': 'Cerebral Blood Flow.', 'article-title': 'Loss of autoregulation produced by cerebral trauma', 'author': 'Reivich', 'year': '1969'} / Cerebral Blood Flow. / Loss of autoregulation produced by cerebral trauma by Reivich (1969)
  45. 10.1093/brain/86.3.425 / Brain / Observations on intracerebral aneurysms. by Ross Russell (1963)
  46. 10.1093/brain/91.2.281 / Brain / Brain swelling produced by injury and aggravated by arterial hypertension. A light and electron microscopic study. by Schutta (1968)
  47. 10.1007/BF03026209 / Can Anaesth Soc J / Anaesthesia for intracranial aneurysms with hypotension and spontaneous respiration. by Sellery (1973)
  48. 10.1097/00000542-197210000-00008 / Anesthesiology / Acute intraoperative intracranial hypertension in neurosurgical patients: mechanical and pharmacologic factors. by Shapiro (1972)
  49. 10.1161/01.RES.37.2.164 / Circ Res / Upper limit of cerebral blood flow autoregulation in experimental renovascular hypertension in the baboon. by Strandgaard (1975)
  50. 10.1136/bmj.1.5852.507 / Br Med J / Autoregulation of brain circulation in severe arterial hypertension. by Strandgaard (1973)
  51. {'key': 'b51', 'series-title': 'Cerebral Blood Flow and Intracranial Pressure.', 'first-page': '11', 'article-title': 'On the myogenic nature of the autoregulation mechanism in the cerebral circulation', 'author': 'Symon', 'year': '1972'} / Cerebral Blood Flow and Intracranial Pressure. / On the myogenic nature of the autoregulation mechanism in the cerebral circulation by Symon (1972)
  52. {'key': 'b52', 'series-title': 'Cerebral Blood Flow and Intracranial Pressure.', 'first-page': '390', 'article-title': 'The use of the Xenon clearance method in subarachnoid haemorrhage: post-operative studies with clinical and angiographic correlation', 'author': 'Symon', 'year': '1972'} / Cerebral Blood Flow and Intracranial Pressure. / The use of the Xenon clearance method in subarachnoid haemorrhage: post-operative studies with clinical and angiographic correlation by Symon (1972)
  53. 10.1161/01.STR.4.2.139 / Stroke / A study of regional autoregulation in the cerebral circulation to increased perfusion pressure in normocapnia and hypercapnia. by Symon (1973)
  54. 10.3171/jns.1953.10.6.0617 / J Neurosurg / Controlled hypotension at intracranial operations. by Wiklund (1953)
  55. 10.3171/jns.1975.43.5.0579 / J Neurosurg / Systemic hypotension in neurosurgery. by Yashon (1975)
Dates
Type When
Created 16 years, 3 months ago (May 7, 2009, 11:17 a.m.)
Deposited 2 years, 10 months ago (Oct. 23, 2022, 9:26 a.m.)
Indexed 5 days, 20 hours ago (Aug. 29, 2025, 6:49 a.m.)
Issued 47 years, 9 months ago (Dec. 1, 1977)
Published 47 years, 9 months ago (Dec. 1, 1977)
Published Print 47 years, 9 months ago (Dec. 1, 1977)
Funders 0

None

@article{Nornes_1977, title={Cerebral arterial blood flow and aneurysm surgery: Part 2: Induced hypotension and autoregulatory capacity}, volume={47}, ISSN={0022-3085}, url={http://dx.doi.org/10.3171/jns.1977.47.6.0819}, DOI={10.3171/jns.1977.47.6.0819}, number={6}, journal={Journal of Neurosurgery}, publisher={Journal of Neurosurgery Publishing Group (JNSPG)}, author={Nornes, Helge and Knutzen, Hanna Berit and Wikeby, Per}, year={1977}, month=dec, pages={819–827} }