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Comparison of static and dynamic cerebral autoregulation under anesthesia influence in a controlled animal model.

Authors
  • Ruesch, Alexander1
  • Acharya, Deepshikha1
  • Schmitt, Samantha1, 2, 3
  • Yang, Jason1
  • Smith, Matthew A1, 2, 3
  • Kainerstorfer, Jana M1, 2
  • 1 Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America. , (United States)
  • 2 Neuroscience Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America. , (United States)
  • 3 Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America. , (United States)
Type
Published Article
Journal
PLoS ONE
Publisher
Public Library of Science
Publication Date
Jan 01, 2021
Volume
16
Issue
1
Identifiers
DOI: 10.1371/journal.pone.0245291
PMID: 33418561
Source
Medline
Language
English
License
Unknown

Abstract

The brain's ability to maintain cerebral blood flow approximately constant despite cerebral perfusion pressure changes is known as cerebral autoregulation (CA) and is governed by vasoconstriction and vasodilation. Cerebral perfusion pressure is defined as the pressure gradient between arterial blood pressure and intracranial pressure. Measuring CA is a challenging task and has created a variety of evaluation methods, which are often categorized as static and dynamic CA assessments. Because CA is quantified as the performance of a regulatory system and no physical ground truth can be measured, conflicting results are reported. The conflict further arises from a lack of healthy volunteer data with respect to cerebral perfusion pressure measurements and the variety of diseases in which CA ability is impaired, including stroke, traumatic brain injury and hydrocephalus. To overcome these differences, we present a healthy non-human primate model in which we can control the ability to autoregulate blood flow through the type of anesthesia (isoflurane vs fentanyl). We show how three different assessment methods can be used to measure CA impairment, and how static and dynamic autoregulation compare under challenges in intracranial pressure and blood pressure. We reconstructed Lassen's curve for two groups of anesthesia, where only the fentanyl anesthetized group yielded the canonical shape. Cerebral perfusion pressure allowed for the best distinction between the fentanyl and isoflurane anesthetized groups. The autoregulatory response time to induced oscillations in intracranial pressure and blood pressure, measured as the phase lag between intracranial pressure and blood pressure, was able to determine autoregulatory impairment in agreement with static autoregulation. Static and dynamic CA both show impairment in high dose isoflurane anesthesia, while low isoflurane in combination with fentanyl anesthesia maintains CA, offering a repeatable animal model for CA studies.

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