Cerebral Blood Perfusion Changes After General Anesthesia for Craniotomy

Study Overview
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Brief Summary
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Few studies look into cerebral blood flow (CBF) changes during emergence from general anesthesia for craniotomy. The purpose of this study is to demonstrate CBF changes during emergence from general anesthesia for craniotomy, through monitoring blood oxygen saturation of jugular vein bulb and transcranial Doppler.

Detailed Description
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30 patients undergoing selective craniotomy (craniotomy group) for supratentorial brain tumor removal and 30 patients undergoing selective abdominal surgery (abdominal surgery group) are planned to be enrolled in the study. Mean blood flow velocity in middle cerebral artery (Vmca), mean arterial pressure (MAP), blood oxygen saturation of jugular vein bulb (SjvO2) (only measured in craniotomy group)and arterial CO2 partial pressure (PaCO2) will be measured before general anesthesia, at tracheal extubation, and 30,60, 90, 120 min after extubation in both groups.

Official Title
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Cerebral Hyperemia During Emergence From General Anesthesia for Craniotomy of Patients With Brain Tumor

Conditions
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Brain Neoplasms, Surgery, Hyperemia

Intervention / Treatment
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* Device: Transcranial Doppler (TCD)
* Procedure: jugular venous bulb catheterization
* Procedure: Tumor removal surgery under general anesthesia
* Procedure: Radial artery catheterization
* Procedure: Abdominal surgery under general anesthesia


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: American Society of Anesthesia (ASA) physical status I or II Scheduled for selective supratentorial tumor removal surgery or major abdominal surgery. Exclusion Criteria: Patients with evidence of systemic hypertension, intracranial hypertension, cerebrovascular diseases, other coexisting medical conditions likely to affect cerebral autoregulation. Preoperatively planned delayed tracheal extubation. Pregnant or nursing women

Ages Eligible for Study
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Minimum Age: 25 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Patients undergoing craniotomy<br>Patients undergoing craniotomy who are scheduled for selective supratentorial tumor removal surgery will be randomly chosen and recruited. Transcranial Doppler (TCD) measures,jugular venous bulb catheterization, radial artery catheterization, and tumor removal surgery under general anesthesia will be performed. | Device: Transcranial Doppler (TCD)<br>* A 2-MHz Transcranial Doppler probe (MULTI-DOP P2.2C; DWL, Elektronische Systeme GmbH, Germany) will be used to measure both sides of Vmca of both patients undergoing craniotomy and patients undergoing abdominal surgery. The signal will be range-gated to a depth of 45 to 60 mm at temporal bone window to achieve the optimal signal according to standard techniques. The measures will be recorded in the operation room before anesthesia, in the recovery room at extubation, 30, 60, 90, and 120 min after extubation.<br>* Other names: TCD;Procedure: jugular venous bulb catheterization<br>* After local anesthesia, a jugular venous bulb catheter(16G, manufactured by Arrow International Inc. USA) will be placed in the dominant side. The proper placement of the tip of the catheter in the jugular bulb will be confirmed later by a postoperative lateral skull X-ray. SjvO2 (blood sample will be drawn slowly at a speed of 2ml per minute) will be measured before anesthesia, at extubation, 30, 60, 90, and 120 min after extubation.<br>* Other names: blood oxygen saturation of jugular vein bulb (SjvO2);Procedure: Tumor removal surgery under general anesthesia<br>* Surgery types include total or subtotal removal of tumors.For all surgical procedures, general anesthesia will be maintained with isoflurane (0.5-1.0 minimal alveolar concentration (MAC) expired), repeated boluses of fentanyl (1 2 µg/kg IV), and continuous vecuronium 50～70 IV. All patients will be mechanical ventilated with oxygen. During anesthesia, blood pressure and heart rate will be kept stable, within ±10% of the preoperative levels. Hematocrit (Hct) will be maintained higher than 30%. After surgery, tracheal extubation will be performed when patients regain full muscle strength, breathe spontaneously with acceptable oxygenation and normocapnia.<br>* Other names: craniotomy under general anesthesia;Procedure: Radial artery catheterization<br>* After local anesthesia, an intra-arterial pressure line(I.V. catheter and pressure line kit are both manufactured by Smiths Medical International Ltd. USA) will be inserted in radial artery. Sample blood will be drawn from the line before anesthesia, at tracheal extubation, and 30, 60, 90, 120 min after tracheal extubation.<br>|
| Active Comparator: Patients undergoing abdominal surgery<br>Randomly chosen patients undergoing selective abdominal surgery. Transcranial Doppler (TCD) measures,radial artery catheterization, and major abdominal surgery under general anesthesia will be performed. | Device: Transcranial Doppler (TCD)<br>* A 2-MHz Transcranial Doppler probe (MULTI-DOP P2.2C; DWL, Elektronische Systeme GmbH, Germany) will be used to measure both sides of Vmca of both patients undergoing craniotomy and patients undergoing abdominal surgery. The signal will be range-gated to a depth of 45 to 60 mm at temporal bone window to achieve the optimal signal according to standard techniques. The measures will be recorded in the operation room before anesthesia, in the recovery room at extubation, 30, 60, 90, and 120 min after extubation.<br>* Other names: TCD;Procedure: Radial artery catheterization<br>* After local anesthesia, an intra-arterial pressure line(I.V. catheter and pressure line kit are both manufactured by Smiths Medical International Ltd. USA) will be inserted in radial artery. Sample blood will be drawn from the line before anesthesia, at tracheal extubation, and 30, 60, 90, 120 min after tracheal extubation.<br>Procedure: Abdominal surgery under general anesthesia<br>* For all surgical procedures, general anesthesia will be maintained with isoflurane (0.5-1.0 minimal alveolar concentration (MAC) expired), repeated boluses of fentanyl (1 2 µg/kg IV), and continuous vecuronium 50～70 IV. All patients will be mechanical ventilated with oxygen. During anesthesia, blood pressure and heart rate will be kept stable, within ±10% of the preoperative levels. Hematocrit (Hct) will be maintained higher than 30%. After surgery, tracheal extubation will be performed when patients regain full muscle strength, breathe spontaneously with acceptable oxygenation and normocapnia.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean Blood Flow Velocity in Middle Cerebral Artery | It was the baseline mean blood flow velocity in middle cerebral artery. | before general anesthesia | 
| Mean Blood Flow Velocity in Middle Cerebral Artery |  | after surgery at extubation (average surgery duration: craniotomy group 214min, abdominal group 207min) | 
| Mean Blood Flow Velocity in Middle Cerebral Artery |  | 30min after extubation | 
| Mean Blood Flow Velocity in Middle Cerebral Artery |  | 60min after extubation | 
| Mean Blood Flow Velocity in Middle Cerebral Artery |  | 90min after extubation | 
| Mean Blood Flow Velocity in Middle Cerebral Artery |  | 120min after extubation | 
| Oxygen Saturation of Jugular Venous Bulb |  | before general anesthesia | 
| Oxygen Saturation of Jugular Venous Bulb |  | at extubation | 
| Oxygen Saturation of Jugular Venous Bulb |  | 30min after extubation | 
| Oxygen Saturation of Jugular Venous Bulb |  | 60min after extubation | 
| Oxygen Saturation of Jugular Venous Bulb |  | 90min after extubation | 
| Oxygen Saturation of Jugular Venous Bulb |  | 120min after extubation | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cerebral blood flow, Transcranial Doppler, Emergence from general anesthesia