129- Relationship between aerobic endurance training and dynamic cerebral blood flow regulation in humans – Ichikawa et al.

Acute exercise and the brain

130- Dynamic exercise improves cognitive function in association with increased prefrontal oxygenation – Endo et al.

Aging, cognitive load and the brain

131-Very-low-frequency oscillations of cerebral hemodynamics and blood pressure are affected by aging and cognitive load – Vermeij et al.

Sex-related differences in the brain

132- Male-female differences in upregulation of vasoconstrictor responses in human cerebral arteries – Ahnstedt et al.

127- Transcranial Doppler ultrasound to assess cerebrovascular reactivity: reliability, reproducibility and effect of posture – McDonnell et al.

Calcium channel blocker and the brain

128- Cerebral oxygenation and haemodynamic effects induced by nimodipine in healthy subjects – Canova et al.

124- Treatment of presumed hypotension in very low birthweight neonates: effects on regional cerebral oxygenation – Garner and Burchfield

Brain autoregulation

125- Regional differences in dynamic cerebral autoregulation in the healthy brain assessed by magnetic resonance imaging – Horsfield et al.

Primary intracerebral hemorrhage and the brain

126- Autoregulation of cerebral blood flow is preserved in primary intracerebral hemorrhage – Gould et al.

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122- Sympathetic regulation of cerebral blood flow in humans: a review – Ter Laan et al.

Anesthesia-induced hypotension and the brain

123- Changes in cerebral tissue oxygen saturation during anaesthetic-induced hypotension: an interpretation based on neurovascular coupling and cerebral autoregulation – Meng et al.

115- The effects of hypertension on the cerebral circulation – Pires et al.

116- Assessment of cerebral oxygenation oscillations in subjects with hypertension – Li et al.

Hyperoxia and the brain

117- Cerebral oxygenation during hyperoxia-induced increase in exercise tolerance for untrained men – Oussaidene et al.

Hypocapnia, hypercapnia and the brain

118- Cerebral vasomotor reactivity during hypo- and hypercapnia in sedentary elderly and Masters athletes – Zhu et al.

Brain autoregulation

119- Reliability, asymmetry, and age influence on dynamic cerebral autoregulation measured by spontaneous fluctuations of blood pressure and cerebral blood flow velocities in healthy individuals – Ortega-Gutierrez et al.

Carotid endarterectomy and the brain

120- Near-infrared spectroscopy can predict the onset of cerebral hyperperfusion syndrome after carotid endarterectomy – Pennekamp et al.

Spinal cord injury and the brain

121- Cerebrovascular responses to orthostatic stress after spinal cord injury – Sahota et al.

Accumulating evidence, published by independent research teams, suggests that the utilization of some vasopressor agents can be associated with a reduction in brain oxygenation monitored by near-infrared spectroscopy. However, the picture isn’t that perfect because other research teams have published the opposite. In upcoming posts, I will discuss results related to that very exciting research area.

I will begin with a small correspondence published last year in the British Journal of Anaesthesia. In this study, phenylephrine (50–100 mg; n=4) and ephedrine (5–10 mg; n=7) were administered in patients undergoing carotid endarterectomy under general anesthesia, in order to correct hypotension (corresponding to a 20% reduction in mean arterial pressure (MAP) vs. preoperative MAP before cross-clamping). MAP, middle cerebral artery flow velocity (MCAVmean; transcranial Doppler) and cerebral oxygenation (near-infrared spectroscopy) were monitored.

The figure below shows the main results of this study.

MAP augmented with both vasopressor agents. Following administration of ephedrine, MCAVmean stayed constant and cerebral oxygenation (rSO2) increased. However, MCAVmean increased while cerebral oxygenation decreased following the administration of phenylephrine. Of interest, heart rate raised with ephedrine and dropped with phenylephrine.

The authors suggest that this reduction in cerebral oxygenation with phenylephrine may be explained by 1) a change (decrease) in cardiac output following administration of this vasopressor or 2) a direct alpha-receptor-mediated cerebral vasoconstriction.

Although the data are very limited, the observations were consistent, since no patients treated with phenylephrine showed an increase in cerebral oxygenation, and no patient in the ephedrine group showed a decrease.

111- Acute volume expansion attenuates hyperthermia-induced reductions in cerebral perfusion during simulated hemorrhage – Schlader et al.

Anesthesia and the brain

112- Cerebral oxygenation in the beach chair position: a prospective study on the effect of general anesthesia compared with regional anesthesia and sedation – Koh et al.

113- Impact of sevoflurane anesthesia on cerebral blood flow in children younger than 2 years – Rhondali et al.

Brain monitoring

114- Comparison of cerebral vascular reactivity measures obtained using breath-holding and CO2 inhalation – Tancredi and Hoge

106- Does stroke subtype and measurement technique influence estimation of cerebral autoregulation in acute ischaemic stroke – Saeed et al.

Cardiopulmonary bypass and the brain

107- Continuous cerebrovascular reactivity monitoring and autoregulation monitoring identify similar lower limits of autoregulation in patients undergoing cardiopulmonary bypass – Blaine Easley et al.

Dehydration and the brain

108- Effect of dehydration on cerebrovascular control during standing after heavy resistance exercise – Moralez et al.

The aging brain

109- Your ageing brain: the lows and highs of cerebral metabolism – Ainslie and Bailey

Vasodilators, vasopressors and the brain

110- Middle cerebral oxygen delivery during the modified oxford maneuver increases with sodium nitroprusside and decreases during phenylephrine – Stewart et al.

102- Life-long aerobic exercise preserved baseline cerebral blood flow but reduced vascular reactivity to CO2 – Thomas et al.

Anti-hypertensive treatment and the brain

103- Intensive blood pressure lowering increases cerebral blood flow in older subjects with hypertension – Tryambake et al.

Diabetes and the brain

104- Positron emission tomography measured cerebral blood flow and glucose metabolism are decreased in human type 1 diabetes – van Golen et al.

Hemodialysis and the brain

105–Cerebrovascular autoregulation in critically ill patients during continuous hemodialysis – Schramm et al.