POS1123 DISORDERS OF URODYNAMICS AND PARENCHYMA CONCENTRATION FUNCTION IN PATIENTS WITH ARTERIAL HYPERTENSION AND GOUT

Background:The combination of arterial hypertension and gout increases the risk of developing chronic kidney disease in patients.Objectives:To assess urodynamics and concentration function of the renal parenchyma in patients with arterial hypertension and gout.Methods:We examined 87 patients with arterial hypertension and gout. 83% of the patients were men with a mean age of 55.4±12.3 years. Grade I arterial hypertension was detected in 43.7% of patients, grade II was in 36.9% and grade III was in 19.3%. The duration of arterial hypertension was 8 [4; 11] years. All the patients had chronic gouty arthritis. 30% of the patients had tophi. The duration of gout was 7 [2; 10] years. Markers of renal lesions, urine sediment and GFR calculation were assessed in all the patients. All the patients were performed a modern systems analysis of nephrological conditions based on comprehensive renoscintigraphy (SENS-CRS) which allows to make an in-depth differential analysis of the renal parenchyma and thus reveals abnormalities in the upper and lower urinary tract function with a minimum of radiation exposure of 0.6 mSv per patient.Results:Using the standard method of GFR calculation with CKD-EPI formula we found that 10 patients (11.3%) had no signs of CKD (GFR over 90 ml/min); 56 patients (64.5%) had I-II stage of CKD (GFR over 60 ml/min) 21 patients (24.2%) had III-IV stage of CKD (GFR less than 60 ml/min).The patients were divided into two groups for a differentiated assessment of urodynamics. Group I consisted of 66 patients with a GFR of more than 60 ml/min and Group II consisted of 21 patients with a GFR of less than 60 ml/min. The comparison of the two groups revealed abnormalities in urodynamics. In Group 1 arterial blood flow in the parenchyma (A 14.5±6.8 sec) was slowing down against the background of normal venous outflow (V 17.8%±9.2%). Concentration function of the kidneys was sufficient (Gren 17.6±5.2 o.e.). The total excretion rate of labeled urine from the two kidneys decreased to D = 56.5% ± 16.1% during its transition from the cortical to the cerebral layer of the renal parenchyma. The indixes of the relative urinary stasis in the renal calyx-pelvis system exceeded the standard ones on average by 2 times (KC 4.8 ± 3.2; KP 7.0 ± 4.2), which indicated stagnant disorders in the kidneys, hidden from conventional diagnostic methods. The patients in Group II had those abnormalities even more expressed (A 12.4±4.5 sec, V 12.8%±9.4%, D 51.9%±15.4%, KC 5.0±3.3; KP 9.5±5.2).16 patients under follow-up who had arterial hypertension with serum creatinine levels greater than 125 μmol/l were classified as a subgroup of patients at an increased risk of developing high stages of CKD. Stages I-II were previously diagnosed in the 16 patients according to the CKD-EPI formula and stage III CKD with a high risk of progression to stage IV CKD was diagnosed in one patient.A comparative analysis of the SENS-CRS data of the patients with arterial hypertension was performed between the above-mentioned 16 patients and the remaining 71 patients. The nonparametric Mann-Whitney method was used (p<0.05) for the purpose. The method was established only by the indicator D (%) of the rate of elimination of the radiopharmaceutical from the renal parenchyma. However, no significant differences were found either for the calculated GFR values, or for all other parameters of complex renoscintigraphyConclusion:After the gout diagnosis is made and confirmed by screening, it is important that patients with gout and hypertension should be included in the nephrologic monitoring system to control risk factors associated with the development or aggravation of CKD.The renocortical parameter D (%), used in the SENS-CRS technology, is a prognostically important preclinical marker of intrarenal congestion in the latent development of serious morphofunctional disorders in the renal parenchyma leading to the development of CKD or the aggravation of an existing stage of CKD.Disclosure of Interests:None declared.

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Oxygen Fraction Adjustment According to Body Surface Area during Extracorporeal Circulation

The Heart Surgery Forum ◽

10.1532/hsf.1325 ◽

2015 ◽

Vol 18 (3) ◽

pp. 098

Author(s):

Cem Arıtürk ◽

Serpil Ustalar Özgen ◽

Behiç Danışan ◽

Hasan Karabulut ◽

Fevzi Toraman

Keyword(s):

Body Temperature ◽

Surface Area ◽

Body Surface Area ◽

Body Surface ◽

Extracorporeal Circulation ◽

Group Iii ◽

Oxygen Fraction ◽

Arterial Blood ◽

Group I ◽

Group Ii

Background: The inspiratory oxygen fraction (FiO2) is usually set between 60% and 100% during conventional extracorporeal circulation (ECC). However, this strategy causes partial oxygen pressure (PaO2) to reach hyperoxemic levels (>180 mmHg). During anesthetic management of cardiothoracic surgery it is important to keep PaO2 levels between 80-180 mmHg. The aim of this study was to assess whether adjusting FiO2 levels in accordance with body temperature and body surface area (BSA) during ECC is an effective method for maintaining normoxemic PaO2 during cardiac surgery.Methods: After approval from the Ethics Committee of the University of Acıbadem, informed consent was given from 60 patients. FiO2 adjustment strategies applied to the patients in the groups were as follows: FiO2 levels were set as 0.21 × BSA during hypothermia and 0.21 × BSA + 10 during rewarming in Group I; 0.18 × BSA during hypothermia and 0.18 × BSA + 15 during rewarming in Group II; and 0.18 × BSA during hypothermia and variable with body temperature during rewarming in Group III. Arterial blood gas values and hemodynamic parameters were recorded before ECC (T1); at the 10th minute of cross clamp (T2); when the esophageal temperature (OT) reached 34°C (T3); when OT reached 36°C (T4); and just before the cessation of ECC (T5).Results: Mean PaO2 was significantly higher in Group I than in Group II at T2 and T3 (P = .0001 and P = .0001, respectively); in Group I than in Group III at T1 (P = .02); and in Group II than in Group III at T2, T3, and T4 (P = .0001 for all). Conclusion: Adjustment of FiO2 according to BSA rather than keeping it at a constant level is more appropriate for keeping PaO2 between safe level limits. However, since oxygen consumption of cells vary with body temperature, it would be appropriate to set FiO2 levels in concordance with the body temperature in the rewarming period.

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Functional adaptation to reduced renal mass in early development

AJP Renal Physiology ◽

10.1152/ajprenal.1982.242.2.f190 ◽

1982 ◽

Vol 242 (2) ◽

pp. F190-F196 ◽

Cited By ~ 3

Author(s):

R. L. Chevalier

Keyword(s):

Renal Mass ◽

Left Kidney ◽

Extracellular Fluid ◽

Functional Adaptation ◽

Fluid Loss ◽

Group Iii ◽

Arterial Blood ◽

India Ink ◽

Group I ◽

Group Ii

To determine whether reduced renal mass in the newborn results in acceleration of normal renal development, the response to unilateral nephrectomy (N) before 36 h of age was compared with sham-operated (S) guinea pigs during the period of most rapid nephron maturation. Studies were performed at 7-13 days (group I) and 19-25 days (group II). Mean arterial blood pressure (AP), left kidney glomerular filtration rate (LKGFR), and urine sodium excretion (UNaV) were measured. Superficial single nephron GFR (sSNGFR) and proximal fractional water reabsorption (FRH2O) were measured by micropuncture, and the number of glomeruli (NG) was determined by India ink perfusion. In view of the susceptibility of the neonate to extracellular fluid loss, groups I and II were plasma infused to maintain euvolemia and group II was compared with 19- to 25-day-old hydropenic animals (group III). Increase in body weight with age was unaffected by neonatal N. In group IN, the compensatory increase in sSNGFR was greater than SNGFR for deeper nephrons, which normally contribute most to GFR at this age. In group IIN there was an 80% adaptive increase in LKGFR that could not be entirely explained by the rise in SNGFR. Since NG in group IIN was greater than in group IIS and similar to that in adulthood, the enhanced adaptation in LKGFR in group IIN may be due in part to earlier recruitment of a population of underperfused glomeruli. FRH2O did not change significantly with age and did not differ in N and S groups. Animals in group III developed a rise in hematocrit during the experiment, and AP, LKGFR, and UNaV were lower in group IIIN than in group IIN. It is concluded that following N at birth, the sequence of renal functional maturation is accelerated while glomerulotubular balance is preserved. As a result of these adaptative changes, homeostasis is maintained and body growth proceeds without impairment.

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Effects of the regional nerve blockade at the limb reperfusion in pediatric orthopedics

Russian Journal of Pediatric Surgery ◽

10.18821/1560-9510-2020-24-5-317-322 ◽

2020 ◽

Vol 24 (5) ◽

pp. 317-322

Author(s):

Olga G. Chekhova ◽

V. A. Ostanina ◽

A. H. Shmakov

Keyword(s):

Regional Anesthesia ◽

Lactate Level ◽

Lactate Concentration ◽

Main Stage ◽

Topical Anesthetic ◽

Nerve Blockade ◽

Arterial Blood ◽

Group I ◽

Group Ii ◽

Arterial Blood Glucose

Introduction. Arterial tourniquets are widely used to improve visualization of the surgical field and to reduce blood loss . However, the resulting ischemia and subsequent reperfusion make doctors seek for better options to reduce these complications. Objective. To find out how the regional nerve blockade impacts the reperfusion of ischemized limb when arterial tourniquets are removed during orthopedic surgeries in children. Material and methods. In 16 patients, who were operated on at the department of trauma and orthopedics of the Novosibirsk Children ‘s Clinical Hospital of Emergency Medical Care (CCHEMC) , surgical intervention required the application of an arterial tourniquet. These patients became participants in an observational pilot study. Patients with tourniquets were divided into two groups: Group I - had the regional nerve blockade ( 9 patients) and Group II - had no regional nerve blockade (7 patients). Parameters of acid-base homeostasis, lactate and arterial blood glucose were assessed in all patients at all stages: before surgery (stage 1), main stage (stage 2), 5 minutes after the tourniquet removal (stage 3). The following parameters were compared in this work: mean arterial pressure (MAP), mm Hg; heart rate (min-1); concentration of lactate in the arterial blood (mmol/l), glycemia (mmol/l). The obtained findings are presented as median (Me) of lower and upper quartiles [Q25; Q75]. Results. The found dynamics of lactate concentration in participants’ blood was the most significant result of the study. In Group I, where regional anesthesia was used, lactate level decreased at the stage 2 and returned to its baseline at the stage 3. In Group II (without regional anesthesia, but with a powerful central analgesic preparation) , lactate level did not change at stage 2, but significantly increased at stage 3. Conclusion. Topical anesthetic (Ropivakaine), used in the regional nerve blockade during orthopedic surgeries in children when arterial tourniquets are put, has less harmful effects in surgical aggression.

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Efficacy of Computer-Assisted Management of Respiratory Failure in Neonates

PEDIATRICS ◽

10.1542/peds.78.1.139 ◽

1986 ◽

Vol 78 (1) ◽

pp. 139-143 ◽

Cited By ~ 1

Author(s):

Waldemar A. Carlo ◽

Lucia Pacifico ◽

Robert L. Chatburn ◽

Avroy A. Fanaroff

Keyword(s):

Respiratory Failure ◽

Computer Program ◽

Computer Assisted ◽

Blood Gas ◽

Arterial Blood Gas ◽

Group Iii ◽

Arterial Blood ◽

Group I ◽

Group Ii ◽

Assisted Management

We modified an algorithm for mechanical ventilation of infants with respiratory distress syndrome to create an interactive user-friendly computer program. To determine the effectiveness of this computer program, we evaluated the correction of deranged arterial blood gases in three groups of neonates: group I, treated before the introduction of the computer into the nursery; group II, managed by pediatric residents with the guidance of the computer program; group III, treated after the introduction of the computer into the nursery but managed without consideration of the computer output. Arterial blood gas values improved more frequently in the neonates managed with computer consultation (group II, 65/75, 87%) than in both control groups (group I, 37/57, 65%, P < .005; and group III, 46/63, 73%, P < .05). Furthermore, increases in ventilatory support in the presence of normal arterial blood gas values occurred only in patients managed without computer guidance. In a teaching institution, more effective care of neonates with respiratory failure may be facilitated by computer-assisted management of mechanical ventilators.

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New approach to decrease post-ERCP adverse events in patients with primary sclerosing cholangitis

Endoscopy International Open ◽

10.1055/s-0043-102398 ◽

2017 ◽

Vol 05 (08) ◽

pp. E710-E717 ◽

Cited By ~ 5

Author(s):

Udayakumar Navaneethan ◽

Dennisdhilak Lourdusamy ◽

Norma Gutierrez ◽

Xiang Zhu ◽

John Vargo ◽

...

Keyword(s):

Adverse Events ◽

Primary Sclerosing Cholangitis ◽

Stent Placement ◽

Sclerosing Cholangitis ◽

Balloon Dilation ◽

Bivariate Analysis ◽

Contrast Injection ◽

Group I ◽

Increased Risk ◽

Group Ii

Abstract Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is often performed in patients with primary sclerosing cholangitis (PSC). Our aim was to validate a treatment approach with the objective of decreasing ERCP related adverse events (AEs). Patients and methods All patients who had undergone ERCP for PSC during the period from 2002 – 2012 were identified (group I). This group had traditional ERCP (no bile aspiration prior to contrast injection with balloon dilation and stent placement for treatment of dominant strictures). To decrease ERCP-related AEs, we changed the ERCP approach in which bile aspiration was performed prior to contrast injection and balloon dilation alone was performed for treatment of dominant strictures. This was tested prospectively in all patients undergoing ERCP for PSC from 2012 – 2014 (group II). Results The risk of overall AEs and cholangitis was relatively less in group II compared with group I [(2.1 % vs. 10.3 %; P = .38) and (0 % vs. 4.4 %; P = .68)]. On bivariate analysis, change in ERCP approach was associated with decreased risk of post-procedure cholangitis (0 % vs. 10.2 %, P = .03) and overall AE (0 % vs. 18.6 %, P = .03). There were no AEs in 22/46 patients in group II who had bile aspiration with balloon dilation. On multivariate analysis, only biliary stent placement was associated with increased risk of AEs (OR 4.10 (1.32 – 12.71); P = .02) and cholangitis (OR 5.43, 1.38 – 21.38; P = .02) respectively. Conclusion Biliary aspiration and avoidance of stenting approach after dilation of strictures during ERCP in PSC patients appears to be associated with decreased risk of cholangitis and overall AEs. Future prospective randomized controlled trials are needed to validate our observation.

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Environmental Assessment and Evaluation of Oxidative Stress and Genotoxicity Biomarkers Related to Chronic Occupational Exposure to Benzene

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16122240 ◽

2019 ◽

Vol 16 (12) ◽

pp. 2240 ◽

Cited By ~ 2

Author(s):

Isabele C. Costa-Amaral ◽

Leandro V. B. Carvalho ◽

Marcus Vinicius C. Santos ◽

Daniel Valente ◽

Angélica C. Pereira ◽

...

Keyword(s):

Oxidative Stress ◽

Occupational Exposure ◽

Chromosomal Abnormalities ◽

Muconic Acid ◽

Work Activities ◽

Nuclear Abnormalities ◽

Filling Station ◽

Group I ◽

Increased Risk ◽

Group Ii

Environmental and occupational exposure to benzene from fuels is a major cause for concern for national and international authorities, as benzene is a known carcinogen in humans and there is no safe limit for exposure to carcinogens. The objective of this study was to evaluate the genotoxic effects of chronic occupational exposure to benzene among two groups of workers: filling station workers (Group I) and security guards working at vehicles entrances (Group II), both on the same busy highway in Rio de Janeiro, Brazil. Sociodemographic data on the workers were evaluated; the concentration of benzene/toluene (B/T) in atmospheric air and individual trans,trans-muconic acid (ttMA) and S-phenylmercapturic acid (S-PMA) were measured; oxidative stress was analyzed by catalase (CAT), glutathione S-transferase (GST), superoxide dismutase (SOD), thiol groups (THIOL) and malondialdehyde (MDA); genotoxicity was measured by metaphases with chromosomal abnormalities (MCA) and nuclear abnormalities, comet assay using the enzyme formamidopyrimidine DNA glycosylase (C-FPG), and methylation of repetitive element LINE-1, CDKN2B and KLF6 genes. Eighty-six workers participated: 51 from Group I and 35 from Group II. The B/T ratio was similar for both groups, but Group I had greater oscillation of benzene concentrations because of their work activities. No differences in ttMA and S-PMA, and no clinical changes were found between both groups, but linearity was observed between leukocyte count and ttMA; and 15% of workers had leukocyte counts less than 4.5 × 109 cells L−1, demanding close worker’s attention. No differences were observed between the two groups for THIOL, MDA, MCA, or nuclear abnormalities. A multiple linear relationship was obtained for the biomarkers MCA and C-FPG. A significant correlation was found between length of time in current job and the biomarkers C-FPG, MCA, GST, and MDA. Although both populations had chronic exposure to benzene, the filling station workers were exposed to higher concentrations of benzene during their work activities, indicating an increased risk of DNA damage.

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Growth differentiation factor-15 levels in the blood around the pulmonary artery is associated with hospitalization for heart failure in patients with pulmonary arterial hypertension

Pulmonary Circulation ◽

10.1177/2045894020962948 ◽

2020 ◽

Vol 10 (4) ◽

pp. 204589402096294

Author(s):

Wei-Ting Chang ◽

Jhih-Yuan Shih ◽

Yu-Wen Lin ◽

Zhih-Cherng Chen ◽

Jun-Neng Roan ◽

...

Keyword(s):

Heart Failure ◽

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Right Atrial ◽

Heart Catheterization ◽

Growth Differentiation Factor 15 ◽

Arterial Blood ◽

Differentiation Factor ◽

Group I ◽

Pulmonary Arterial

Despite no significant differences of growth differentiation factor-15 expressions in peripheral, right atrial, and right ventricular blood, in the pulmonary arterial blood, there was a significantly high level of growth differentiation factor-15 in Group I pulmonary arterial hypertension patients subsequently developing heart failure. During right heart catheterization, collecting pulmonary blood samples is suggested to measure growth differentiation factor-15.

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Identification of 18 vector species belonging to Group I, Group II, and Group III ‘Dirty 22’ species known to contaminate food and spread foodborne pathogens: DNA barcoding study of public health importance

International Journal of Tropical Insect Science ◽

10.1017/s1742758416000217 ◽

2016 ◽

Vol 37 (01) ◽

pp. 1-10 ◽

Cited By ~ 2

Author(s):

Irshad M. Sulaiman ◽

Emily Jacobs ◽

Steven Simpson ◽

Khalil Kerdahi

Keyword(s):

Public Health ◽

Foodborne Pathogens ◽

Species Group ◽

Diagnostic Methods ◽

Coi Gene ◽

Public Health Importance ◽

Group Iii ◽

Group I ◽

Coi Barcoding ◽

Group Ii

AbstractThe US Food and Drug Administration (US-FDA) uses the presence of filth and extraneous materials as one of the criteria in implementing regulatory actions and assessing food adulteration of public health importance. So far, 22 common pest species (‘Dirty 22’ species) have been considered by this agency for the spreading of foodborne illness, and their presence is an indicator of unsanitary conditions in food processing and storage facilities. Recently, we classified the ‘Dirty 22’ species into four groups: Group I (four cockroach species), Group II (two ant species), Group III (12 fly species), and Group IV (four rodent species), and described two molecular diagnostic methods for group-specific identification. We developed a PCR-RFLP assay based on rRNA gene for the detection and differentiation of Group I ‘Dirty 22’ species. Later, we designed three Group II ‘Dirty 22’ species-specific nested PCR primer sets and sequence characterized the rRNA, elongation factor 1-alpha (EF-1a), and wingless (WNT-1) loci. In this follow-up study, we have evaluated the robustness of five unique sets of published primers targeting the mitochondrial cytochrome oxidase I (COI) gene for insect barcoding. With modified PCR conditions, we successfully used COI barcoding for 18 members of Group I, Group II, and Group III ‘Dirty 22’ species. Results of this study reveal that COI barcoding is an effective tool for rapid identification of insects of Groups I, II, and III ‘Dirty 22’ species known to contaminate food and spread foodborne pathogens.

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Safety and Efficacy of Low-Molecular-Weight Heparin in Pregnant Women at Increased Risk of Venous Thromboembolism: A Prospective Stratified Multicentre Trial.

Blood ◽

10.1182/blood.v108.11.715.715 ◽

2006 ◽

Vol 108 (11) ◽

pp. 715-715

Author(s):

Rupert M. Bauersachs ◽

Joachim Dudenhausen ◽

Andree Faridi ◽

Thorsten Fischer ◽

Samson Fung ◽

...

Keyword(s):

Venous Thromboembolism ◽

Pregnant Women ◽

Risk Group ◽

High Risk Group ◽

Group Iii ◽

Group I ◽

Increased Risk ◽

At Deficiency ◽

Group Ii ◽

Heparin Prophylaxis

Abstract Women with a history of VTE, thrombophilia or both are at increased risk for VTE during pregnancy, but the optimal management strategy, and the need for thromboprophylaxis is not well defined in clinical guidelines because of limited trial data. The EThIG (Efficacy of Thromboprophylaxis as an Intervention during Gravidity) is a multicenter trial that prospectively enrolled 810 pregnant women at risk of VTE. Women were assigned to one of 3 management strategies: Low risk group I (including women with prior secondary VTE, or asymptomatic thrombophilia) with “watchful waiting” management, and dalteparin prophylaxis postpartum (50–100 IU/kg), or earlier if additional risk factors occurred; high risk group II (e.g. idiopathic VTE or symptomatic thrombophilia) receiving 50–100 IU/kg dalteparin; and very high-risk group III (e.g. acute VTE, prior long-term OAC, symptomatic AT-deficiency or antiphospholipid syndrome), receiving 100–200 IU/kg dalteparin. Primary efficacy outcome measure was symptomatic VTE, main safety outcome measures were haemorrhages, osteoporosis, thromboctopenia and pregnancy outcome. Results (mean ± SD / 95% CI): 810 women (age 30.8±5.4 years, weight 73.6±16.1kg) were enrolled, 28 % in group I, 58 % in II and 14% in III, including 66 women with acute VTE. 60.1% had prior VTE, 75.4% had thrombophilia (42.1 % FV-Leiden, 2.1 % homozygous, 9.5 % FII G20210A, 4.1% PC-, 1 % AT-deficiency; 17.4 % APS). 35.8 % had previous miscarriage, still birth or physical malformation. Comorbid conditions included lupus erythematosus, liver transplantation, ventricular septum defect, paraplegia, hepatitis C, nephrotic syndrome, asthma, chronic haemolytic anaemia, thalassaemia, osteoporosis and thrombocytopaenia. Median treatment initiation was at 17.0 weeks, at 24.0 weeks in group I, 14.5 weeks in group II and 16.0 weeks for group III. Mean daily dose was 66.2 ± 22.5 IU per kg (group I), 76.8 ± 24.1 IU per kg (group II) and 120.0 ± 49.1 IU per kg (group III). Objectively confirmed, symptomatic VTE occurred in 5 of 810 women (0.6%;0.2–1.5%). The rate of serious bleeding was 3.0% (1.9–4.4%), 0.9% (0.3–1.8%) occurred in the antepartum period, 2.1% (1.3–3.4%) peri-partum;1.1% (0.5–2.2%) was possibly heparin-related. There was no evidence of heparin-induced thrombocytopenia, and one case of osteoporosis (fracture of the saccygous bone during delivery). There were 94.4% successful pregnancies, 40 foetuses (4.9%; 3.6–6.7%) were lost due to miscarriage, 7 due to elective termination. Risk-stratified heparin prophylaxis was associated with a low incidence of symptomatic venous thromboembolism and few clinically important adverse events. Antepartum heparin prophylaxis is warranted in pregnant women with prior idiopathic thrombosis or symptomatic thrombophilia.

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Effects of profound hypotension on cerebral blood flow during surgery for intracranial aneurysms

Journal of Neurosurgery ◽

10.3171/jns.1981.55.6.0857 ◽

1981 ◽

Vol 55 (6) ◽

pp. 857-864 ◽

Cited By ~ 76

Author(s):

J. Keith Farrar ◽

Francis W. Gamache ◽

Gary G. Ferguson ◽

John Barker ◽

George P. Varkey ◽

...

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Neurological Status ◽

Neurological Deficits ◽

Arterial Spasm ◽

Arterial Blood ◽

Flow Disturbances ◽

Group I ◽

Increased Risk ◽

Profound Hypotension

✓ The progression of changes in cerebral blood flow (CBF) and neurological status were measured in 12 patients in whom profound hypotension (mean arterial blood pressure (MABP): 30 to 40 mm Hg) was used during intracranial aneurysm surgery. Nine patients (Group I) showed autoregulation of CBF to an MABP of 40 to 50 mm Hg during surgery. None of these patients had arterial spasm preoperatively. Postoperatively, mild flow disturbances were noted at the site of retraction. Three Group I patients developed arterial spasm postoperatively, but there was no associated neurological deterioration. The remaining three patients (Group II) had impaired autoregulation during surgery, and CBF decreased by 35% to 65% at an MABP of 50 mm Hg. Two of these patients had angiography immediately before surgery, and both showed moderate to severe arterial spasm. Relatively severe flow disturbances were noted postoperatively at the site of retraction, and two patients developed ischemic deficits of late onset. Brain retractor pressure and the degree and duration of hypotension were equivalent in the two patient groups. There was no correlation between intraoperative reductions in CBF (to as low as 20 ml/100 gm/min in the unretracted hemisphere) and immediate postoperative neurological deficits. The use of halothane and mannitol and the relatively short duration of the flow reductions were suggested as factors contributing to the protection from ischemia that was observed. Arterial spasm was found to produce hemodynamic instability and reduced CBF, although neurological status was unaffected in the majority of patients. Patients with impaired autoregulation during surgery were at increased risk of delayed ischemic complications postoperatively, and showed characteristic flow disturbances at all three stages of their clinical course.

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