Regional cerebral blood flow following resuscitation from hemorrhagic shock with hypertonic saline. Influence of a subdural mass

Donald Prough, J. M. Whitley, C. L. Taylor, D. D. Deal, Douglas Dewitt

Research output: Contribution to journalArticle

90 Citations (Scopus)

Abstract

After severe hemorrhage, hypertonic saline restores systemic hemodynamics and decreases intracranial pressure (ICP), but its effects on regional cerebral blood flow (rCBF) when used for resuscitation of experimental animals with combined shock and intracranial hypertension have not been reported. We compared rCBF changes (by radiolabeled microsphere technique) after resuscitation from hemorrhage with either 0.8 or 7.2% saline in animals with and without a right hemispheric subdural mass. We studied 24 mongrel dogs anesthetized with 0.5% halothane and 60% nitrous oxide. In group 1 (n = 12), hemorrhage reduced mean arterial pressure (MAP) to 45 mmHg for 30 min. In group 2 (n = 12), ICP was increased and maintained constant at 15 mmHg, whereas hemorrhage reduced MAP to 55 mmHg for 30 min (cerebral perfusion pressure [CPP] ~ 40 mmHg in each group). After the 30-min shock period, 6 animals in each group received one of two randomly assigned resuscitation fluids over a 5-min interval: 1) 7.2% hypertonic saline (HS; sodium 1,232 mEq·l-1, volume 6.0 ml·kg-1); or 2) 0.8% isotonic saline (SAL; sodium 137 mEq·l-1, volume 54 ml·kg-1). Once fluid resuscitation began, ICP was permitted to vary independently in both groups. Data were collected at baseline (before subdural balloon inflation in group 2), midway through the shock interval (T15), immediately after fluid infusion (T35), and 60 and 90 min later (T95, T155). In groups 1 and 2, ICP was significantly less in animals resuscitated with HS compared to those receiving SAL (P < 0.05). In group 2, rCBF in the right hemisphere was significantly greater in HS-treated than in SAL-treated dogs (P < 0.05). We conclude that when used for resuscitation from hemorrhagic shock with associated intracranial hypertension, 7.2% HS reduces ICP and increases rCBF.

Original languageEnglish (US)
Pages (from-to)319-327
Number of pages9
JournalAnesthesiology
Volume75
Issue number2
StatePublished - 1991
Externally publishedYes

Fingerprint

Cerebrovascular Circulation
Hemorrhagic Shock
Regional Blood Flow
Resuscitation
Intracranial Pressure
Intracranial Hypertension
Hemorrhage
Shock
Arterial Pressure
Sodium
Dogs
Economic Inflation
Nitrous Oxide
Halothane
Microspheres
Hemodynamics

Keywords

  • Brain, subdural mass: cerebral blood flow; intracranial pressure
  • Hypertonic saline
  • Shock

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Regional cerebral blood flow following resuscitation from hemorrhagic shock with hypertonic saline. Influence of a subdural mass. / Prough, Donald; Whitley, J. M.; Taylor, C. L.; Deal, D. D.; Dewitt, Douglas.

In: Anesthesiology, Vol. 75, No. 2, 1991, p. 319-327.

Research output: Contribution to journalArticle

@article{48e2b33ed371488aa8c8729e2707c915,
title = "Regional cerebral blood flow following resuscitation from hemorrhagic shock with hypertonic saline. Influence of a subdural mass",
abstract = "After severe hemorrhage, hypertonic saline restores systemic hemodynamics and decreases intracranial pressure (ICP), but its effects on regional cerebral blood flow (rCBF) when used for resuscitation of experimental animals with combined shock and intracranial hypertension have not been reported. We compared rCBF changes (by radiolabeled microsphere technique) after resuscitation from hemorrhage with either 0.8 or 7.2{\%} saline in animals with and without a right hemispheric subdural mass. We studied 24 mongrel dogs anesthetized with 0.5{\%} halothane and 60{\%} nitrous oxide. In group 1 (n = 12), hemorrhage reduced mean arterial pressure (MAP) to 45 mmHg for 30 min. In group 2 (n = 12), ICP was increased and maintained constant at 15 mmHg, whereas hemorrhage reduced MAP to 55 mmHg for 30 min (cerebral perfusion pressure [CPP] ~ 40 mmHg in each group). After the 30-min shock period, 6 animals in each group received one of two randomly assigned resuscitation fluids over a 5-min interval: 1) 7.2{\%} hypertonic saline (HS; sodium 1,232 mEq·l-1, volume 6.0 ml·kg-1); or 2) 0.8{\%} isotonic saline (SAL; sodium 137 mEq·l-1, volume 54 ml·kg-1). Once fluid resuscitation began, ICP was permitted to vary independently in both groups. Data were collected at baseline (before subdural balloon inflation in group 2), midway through the shock interval (T15), immediately after fluid infusion (T35), and 60 and 90 min later (T95, T155). In groups 1 and 2, ICP was significantly less in animals resuscitated with HS compared to those receiving SAL (P < 0.05). In group 2, rCBF in the right hemisphere was significantly greater in HS-treated than in SAL-treated dogs (P < 0.05). We conclude that when used for resuscitation from hemorrhagic shock with associated intracranial hypertension, 7.2{\%} HS reduces ICP and increases rCBF.",
keywords = "Brain, subdural mass: cerebral blood flow; intracranial pressure, Hypertonic saline, Shock",
author = "Donald Prough and Whitley, {J. M.} and Taylor, {C. L.} and Deal, {D. D.} and Douglas Dewitt",
year = "1991",
language = "English (US)",
volume = "75",
pages = "319--327",
journal = "Anesthesiology",
issn = "0003-3022",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Regional cerebral blood flow following resuscitation from hemorrhagic shock with hypertonic saline. Influence of a subdural mass

AU - Prough, Donald

AU - Whitley, J. M.

AU - Taylor, C. L.

AU - Deal, D. D.

AU - Dewitt, Douglas

PY - 1991

Y1 - 1991

N2 - After severe hemorrhage, hypertonic saline restores systemic hemodynamics and decreases intracranial pressure (ICP), but its effects on regional cerebral blood flow (rCBF) when used for resuscitation of experimental animals with combined shock and intracranial hypertension have not been reported. We compared rCBF changes (by radiolabeled microsphere technique) after resuscitation from hemorrhage with either 0.8 or 7.2% saline in animals with and without a right hemispheric subdural mass. We studied 24 mongrel dogs anesthetized with 0.5% halothane and 60% nitrous oxide. In group 1 (n = 12), hemorrhage reduced mean arterial pressure (MAP) to 45 mmHg for 30 min. In group 2 (n = 12), ICP was increased and maintained constant at 15 mmHg, whereas hemorrhage reduced MAP to 55 mmHg for 30 min (cerebral perfusion pressure [CPP] ~ 40 mmHg in each group). After the 30-min shock period, 6 animals in each group received one of two randomly assigned resuscitation fluids over a 5-min interval: 1) 7.2% hypertonic saline (HS; sodium 1,232 mEq·l-1, volume 6.0 ml·kg-1); or 2) 0.8% isotonic saline (SAL; sodium 137 mEq·l-1, volume 54 ml·kg-1). Once fluid resuscitation began, ICP was permitted to vary independently in both groups. Data were collected at baseline (before subdural balloon inflation in group 2), midway through the shock interval (T15), immediately after fluid infusion (T35), and 60 and 90 min later (T95, T155). In groups 1 and 2, ICP was significantly less in animals resuscitated with HS compared to those receiving SAL (P < 0.05). In group 2, rCBF in the right hemisphere was significantly greater in HS-treated than in SAL-treated dogs (P < 0.05). We conclude that when used for resuscitation from hemorrhagic shock with associated intracranial hypertension, 7.2% HS reduces ICP and increases rCBF.

AB - After severe hemorrhage, hypertonic saline restores systemic hemodynamics and decreases intracranial pressure (ICP), but its effects on regional cerebral blood flow (rCBF) when used for resuscitation of experimental animals with combined shock and intracranial hypertension have not been reported. We compared rCBF changes (by radiolabeled microsphere technique) after resuscitation from hemorrhage with either 0.8 or 7.2% saline in animals with and without a right hemispheric subdural mass. We studied 24 mongrel dogs anesthetized with 0.5% halothane and 60% nitrous oxide. In group 1 (n = 12), hemorrhage reduced mean arterial pressure (MAP) to 45 mmHg for 30 min. In group 2 (n = 12), ICP was increased and maintained constant at 15 mmHg, whereas hemorrhage reduced MAP to 55 mmHg for 30 min (cerebral perfusion pressure [CPP] ~ 40 mmHg in each group). After the 30-min shock period, 6 animals in each group received one of two randomly assigned resuscitation fluids over a 5-min interval: 1) 7.2% hypertonic saline (HS; sodium 1,232 mEq·l-1, volume 6.0 ml·kg-1); or 2) 0.8% isotonic saline (SAL; sodium 137 mEq·l-1, volume 54 ml·kg-1). Once fluid resuscitation began, ICP was permitted to vary independently in both groups. Data were collected at baseline (before subdural balloon inflation in group 2), midway through the shock interval (T15), immediately after fluid infusion (T35), and 60 and 90 min later (T95, T155). In groups 1 and 2, ICP was significantly less in animals resuscitated with HS compared to those receiving SAL (P < 0.05). In group 2, rCBF in the right hemisphere was significantly greater in HS-treated than in SAL-treated dogs (P < 0.05). We conclude that when used for resuscitation from hemorrhagic shock with associated intracranial hypertension, 7.2% HS reduces ICP and increases rCBF.

KW - Brain, subdural mass: cerebral blood flow; intracranial pressure

KW - Hypertonic saline

KW - Shock

UR - http://www.scopus.com/inward/record.url?scp=0025982984&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0025982984&partnerID=8YFLogxK

M3 - Article

VL - 75

SP - 319

EP - 327

JO - Anesthesiology

JF - Anesthesiology

SN - 0003-3022

IS - 2

ER -