| Title: |
Intraoperative change in baroreceptor function during carotid endarterectomy |
| Authors: |
Gaunt, M E; Sigaudo-Roussel, D; Panerai, R; Evans, D H; London, N L; Naylor, A R; Bell, P R F |
| Source: |
Journal of British Surgery ; volume 87, issue 4, page 494-495 ; ISSN 0007-1323 1365-2168 |
| Publisher Information: |
Oxford University Press (OUP) |
| Publication Year: |
2000 |
| Description: |
Background Labile blood pressure following carotid endarterectomy (CEA) is common and is associated with perioperative myocardial infarction and intracranial haemorrhage. Previous studies have identified that alteration in carotid baroreceptor function is responsible for the blood pressure changes although the mechanism remains unclear. This study aimed to identify the mechanism by which CEA affects baroreceptor function. Methods Fifty patients were recruited prospectively and underwent estimation of baroreceptor sensitivity (BRS) during a 10-min period of supine bed rest using electrocardiography and Finapres, 2 days before and 2 days to 6 weeks after surgery. During surgery continuous measurements of blood pressure (intra-arterial) and heart rate were recorded on to digital audio tape for postoperative analysis. During analysis the operation was divided into different stages to identify at which stage baroreceptor function altered. Particular attention was paid to initial clamping of the carotid artery, performance of the endarterectomy and final restoration of blood flow. In addition the carotid sinus area was stimulated by stroking the inside of the artery before and after removal of the plaque. Autonomic activity was calculated using power spectral analysis of beat-to-beat blood pressure and the R–R interval from the electrocardiograph. BRS was estimated by calculation of the square root of the ratio of the powers of R–R interval and systolic blood pressure to give the alpha index which has been shown to correlate well with BRS calculated by means of standard pharmacological techniques. Results For this cohort of patients BRS was significantly reduced 2 days after surgery compared with the preoperative recordings (2·8(0·4) to 5·6(0·8)). Six weeks after operation BRS had improved but had not achieved preoperative levels (3·8(0·6) to 5·6(0·8)). During surgery, patients with good baroreceptor function identified before operation experienced a rise in blood pressure on initial carotid clamping ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1046/j.1365-2168.2000.01420-13.x |
| Availability: |
https://doi.org/10.1046/j.1365-2168.2000.01420-13.x; https://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1046%2Fj.1365-2168.2000.01420-13.x; https://academic.oup.com/bjs/article-pdf/87/4/494/59438844/bjs460.pdf |
| Rights: |
https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model |
| Accession Number: |
edsbas.BFC286D4 |
| Database: |
BASE |