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Cerebral haemodynamics in patients with chronic renal failure: effects of haemodialysis
Authors:Skinner H  Mackaness C  Bedforth N  Mahajan R
Institution:1 Department of Anaesthesia, Nottingham City Hospital and Queen's Medical Centre, Nottingham, UK. 2 Department of Anaesthesia, Derby Royal Infirmary, London Road, Derby, UK
Abstract:Background. We measured middle cerebral artery (MCA) flow velocity(FV), dynamic pressure autoregulation, and carbon dioxide reactivity(CRCO2) in patients with chronic renal failure before and afterhaemodialysis using transcranial Doppler ultrasonography. Methods. Twelve patients on long-term haemodialysis were recruited.MCA FV was measured continuously. The transient hyperaemic responsetest was used to assess cerebral autoregulation, and per centchange in FV per kPa change in end-tidal carbon dioxide wascalculated to assess CRCO2. All measurements were recorded beforeand after haemodialysis. Results. MCA FV (mean SD]) decreased from 57 (10) cm s–1before to 46 (13) cm s–1 after haemodialysis (P<0.01).The transient hyperaemic response ratio (THRR) was (mean SD])1.29 (0.13) before haemodialysis and did not change significantlyfollowing haemodialysis (1.36 0.10]). CRCO2 was 21.7 (8.3)%kPa–1 before haemodialysis and remained unchanged afterwards(20.9 3.8]% kPa–1). Values in normal subjects for MCAFV, THRR and CRCO2 are 56 (12) cm s–1, 1.26 (0.13) and22 (6)% kPa–1, respectively. Conclusions. MCA FV decreases significantly after haemodialysis.Dynamic pressure autoregulation and CRCO2 remain normal in patientswith chronic renal failure, and are not altered significantlyby haemodialysis. {dagger} Presented at the European Society of Anaesthesiologists AnnualCongress Amsterdam, May 1999.
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