
13 Jan. 2022 Monitoring of cerebral autoregulation in Anaesthesiology
TCD in Anaesthesiology for ICU and surgery
Preservation and monitoring of sufficient brain perfusion is an essential part of anaesthesiology and intensive care medicine. Transcranial Doppler Sonography is a non-invasive method, which provides real-time information about the cerebral haemodynamical situation.
For instance, determination of cerebral autoregulation becomes more and more important in the field of anaesthesiology. In case of impaired autoregulation (e.g. following cranial trauma or stroke) brain perfusion depends increasingly on systemic arterial blood pressure. Thus, patients suffering from impaired cerebral autoregulation are at higher risk of cerebral damage due to systemic hypo- or hyperperfusion than healthy subjects.
In anaesthesiology, TCD can not only be used to detect high risk patients preoperatively but also to determine cerebral blood flow (velocity) intraoperative, which, in turn, allows early detection of cerebral hypoperfusion for early and optimal adjustment of narcosis.
At intensive care units and in anaesthesiology, medical doctors can take advantage of these examinations for monitoring of patients suffering from traumatic brain injury or patients at risk of vasospasm development. Some authors conclude that this advantage becomes especially important due to combination of TCD with other neuromonitoring tools.
Newer literature allows an interesting look ahead: it might become possible to assess intracranial pressure by TCD measurements, which could be especially interesting in the setting of intensive care units and emergency rooms. Currently, these studies are still ongoing and conclusive results are pending.