Effects of hyperventilation on cerebral blood flow and brain tissue metabolism in normotensive and spontaneously hypertensive rats

Management Strategies for Intracranial Pressure Crises in Subarachnoid Hemorrhage

Objectives: Standard management strategies for lowering intracranial pressure (ICP) in traumatic brain injury has been well-studied, but the use of lesser known interventions for ICP in subarachnoid hemorrhage (SAH) remains elusive. Searches were performed in PubMed and EBSCO Host to identify best available evidence for evaluation and management of medically refractory ICP in SAH. The role of standard management strategies such as head elevation, hyperventilation, mannitol and hypertonic saline as well as lesser known management such as sodium bicarbonate, indomethacin, tromethamine, decompressive craniectomy, decompressive laparotomy, hypothermia, and barbiturate coma are reviewed. We also included dose concentrations, dose frequency, infusion volume, and infusion rate for these lesser known strategies. Nonetheless, there is still a gap in the evidence to recommend optimal dosing, timing and its role in the improvement of outcomes but early diagnosis and appropriate management reduce adverse outcomes.

Effects of alterations in arterial CO2 tension on cerebral blood flow during acute intracranial hypertension in rats

Cerebrovascular reactivity to CO2 in clinical and experimental studies has been found to be impaired during increased intracranial pressure (ICP). However, from previous study results it has not been possible to estimate whether the impairment was caused by elevated ICP, or caused by decreased cerebral perfusion pressure (CPP). The current study was carried out in a group of unmanipulated control rats and in six investigation groups of six rats each: two groups with elevated ICP (30 and 50 mm Hg) and spontaneous arterial blood pressure (MABP), two groups with spontaneous ICP and arterial hypotension (77 and 64 mm Hg), and two groups with elevated ICP (30 and 50 mm Hg) and arterial hypertension (124 mm Hg). Intracranial hypertension was induced by continuous infusion of lactated Ringer's solution into the cisterna magna, arterial hypotension by controlled bleeding, and arterial hypertension by continuous administration of norepinephrine intravenously. Cerebral blood flow (CBF) was measured repetitively by the intraarterial 133Xe method at different levels of arterial PCO2. In each individual animal, CO2 reactivity was calculated from an exponential regression line obtained from the corresponding CBF/PaCO2 values. By plotting each individual value of CO2 reactivity against the corresponding CPP value from the seven investigation groups, CPP was significantly and directly related to CO2 reactivity of CBF (P < .001). No correlation was found by plotting CO2 reactivity values against the corresponding MABP values or the corresponding ICP values. Thus, the results show that CO2 reactivity is at least partially determined by CPP and that the impaired CO2 reactivity observed at intracranial hypertension and arterial hypotension may be caused by reduced CPP.

Evolution of microcirculatory disturbances after permanent middle cerebral artery occlusion in rats

Nonischemic brain capillaries show a continuous and heterogeneous plasma perfusion. In the current study, plasma perfusion was investigated in rats during 2 to 168 hours of permanent middle cerebral artery occlusion. Perfused capillaries were detected in brain cryosections by fluorescein isothiocyanate (FITC) dextran after 10 minutes of circulation time. Heterogeneity of capillary perfusion was identified by Evans blue (EB), which circulated for 3 seconds. In this setting, the heterogeneity of intracapillary EB concentrations reflects heterogeneities in capillary flow velocities. The CBF was quantified by simultaneous iodo[14C]antipyrine autoradiography. When moving from normal flow to low-flow areas in the ischemic hemisphere, three states of capillary filling could be distinguished: state 1--fast perfusion, filling by FITC dextran and EB (CBF 0.33 mL x g(-1) x min(-1)); state 2--delayed perfusion, only FITC dextran filling (CBF 0.104 mL x g(-1) x min(-1)); state 3--minimal perfusion, no dye filling (CBF 0.056 mL x g(-1) x min(-1)). In tissue of state 1 at the borderline to ischemic tissue, a higher heterogeneity of intracapillary EB concentration (85.7%) was found than in the contralateral nonischemic hemisphere (76.4%) (P < 0.05), indicating a compromised microcirculation. The adjacent ischemic areas were filled by FITC dextran (state 2) 2 to 4 hours after middle cerebral artery occlusion, indicating a maintained, although slow, perfusion at this time. Later, minimal perfused areas (state 3) progressively replaced the delayed perfused areas (state 2). This study shows, for the first time, the evolution of microvascular disturbances in relation to CBF. In the low-flow areas, an early residual plasma perfusion is later followed by a lack of perfusion or minimal perfusion. In areas of higher, although reduced flow at the border between normal and ischemic tissue, an extreme capillary perfusion heterogeneity indicates permanent microcirculatory abnormalities.

Changes in cranial and rectal temperature, blood pressure and arterial blood gas during and after unilateral and bilateral forebrain ischemia in Mongolian gerbils

Transient forebrain ischemia was produced by occluding the common carotid arteries, either unilaterally or bilaterally, in Mongolian gerbils under halothane anesthesia. After 20-min ischemia, the cranial temperature measured in the temporal muscle decreased compared to the preischemic level, the decrease being larger after the bilateral than after the unilateral occlusion. After recirculation, cranial temperature recovered promptly to the preischemic level in the unilateral group, while it was elevated to above the preischemic level in the bilateral group. The rectal temperature also decreased with a similar time course. During 30-min ischemia, the blood pressure of both groups increased to above the preischemic level, the increase being larger in the bilateral group than in the unilateral group. After recirculation, blood pressure of the unilateral group recovered promptly to the preischemic level, while that of the bilateral group decreased to below the preischemic level. When forebrain ischemia was produced immediately after cessation of halothane inhalation, blood pH, PaO2 or PaCO2 did not change significantly from the control level. However, these values showed larger variation in the bilateral group than in the unilateral group. Unilateral occlusion in preselected gerbils provided a good model of transient brain ischemia, giving rise to uniform experimental results.

Repeated measurements of cerebral blood flow in rats. Comparisons between the hydrogen clearance method and laser Doppler flowmetry

Changes in cerebral blood flow (CBF), in chloralose-anaesthetized spontaneously hypertensive rats, were measured simultaneously with the hydrogen clearance (HC) method and laser Doppler flowmetry (LDFM) in order to examine the correlation between results obtained with the two techniques. To induce changes in CBF the rats were bled and CBF measured at different levels of mean arterial pressure. As would be expected, with the platinum electrode at the depth of about 1 mm in the somatosensory cortex, HC gave biexponential curves reflecting clearance in two distinct compartments. During control situation the HC method gave the following values (mean +/- SE, n = 20, ml min-1 100 g-1): fast (fCBF) 158.6 +/- 11.5, slow (sCBF) 29.1 +/- 1.6 with a weighted mean flow (mCBF) of 83.3 +/- 7.4. These fCBF and sCBF values correspond well to those of others obtained with [14C]iodoantipyrine autoradiography in the cerebral cortex and corpus callosum, and better than the results of other studies using HC in rats. Our results, comparing data from HC and LDFM, show a linear relationship between relative values of blood flow changes, the coefficients being 0.658, 0.876 and 0.878 for the correlation between the LDFM data and relative changes in fCBF, sCBF and mCBF, respectively. All three regression lines were significantly different from the line of identity. Much of the discrepancy between the two methods may be related to limitations inherent in each of them, despite efforts to minimize their effects. Thus the depth sensitivity of LDFM in the brain may be greater than expected. In conclusion, the laser Doppler method seems, nevertheless, to be most useful for continuous estimations of changes in cerebral blood flow.

Carbon dioxide reactivity of cerebral cortical and pial arteries in spontaneously hypertensive and normotensive rats--a morphometric study

The responsiveness of cerebral arteries to the changes in arterial carbon dioxide tension (paCO2) was studied in spontaneously hypertensive rats (SHRs) and normotensive rats (NTRs). A freeze substitution method was applied for the preparation of pial and cortical arteries for morphometrical study. Hypercapnia was induced by giving 8% CO2, and hypocapnia was provided by hyperventilation. The ratios of internal (d) to external diameter (D) (d/D ratio) of both pial and cortical arteries in SHR were not different from those in NTRs during normocapnia. In hypercapnia, the ratios of pial and larger cortical arteries (D greater than or equal to 20 micron) in SHRs were 80.9 +/- 0.8% and 78.6 +/- 0.6%, respectively, being significantly smaller than 86.2 +/- 0.7% and 82.2 +/- 0.5% in NTR. In contrast, the d/D ratio of pial arteries in hypocapnia was 72.5 +/- 1.4% in SHRs, which was significantly larger than 67.5 +/- 1.4% in NTRs. The responsiveness of smaller cortical arteries (D less than 20 micron) to paCO2 was not different between SHRs and NTRs. The present results suggest that in SHRs cerebrovascular CO2 reactivity is decreased as compared to NTRs, especially in pial and larger cortical arteries.

Cerebral physiological and metabolic effects of hyperventilation in the neonatal dog

To clarify the changes that occur during marked hypocarbia in the neonate, we measured brain blood flow and metabolite levels after 90 minutes of hyperventilation in neonatal dogs. Brain blood flow decreased significantly in diencephalon, brainstem, and spinal cord but not in cerebral cortex or white matter. There was no substantial change in the electroencephalogram. Lactate concentrations, both in telencephalon and in superior sagittal sinus blood, increased significantly, although there was no alteration in levels of ATP or phosphocreatine. Marked hypocarbia in the neonatal dog produces an elevated brain lactate level that may be related to changes in glycolytic rate rather than to tissue ischemia or hypoxia.