Cerebral Blood Flow Autoregulation and Dysautoregulation

Abstract

This article provides a review of cerebral autoregulation, particularly as it relates to the clinician scientist experienced in neuroscience in anesthesia and critical care. Topics covered are biological mechanisms; methods used for assessment of autoregulation; effects of anesthetics; role in control of cerebral hemodynamics in health and disease; and emerging areas, such as role of age and sex in contribution to dysautoregulation. Emphasis is placed on bidirectional translational research wherein the clinical informs the study design of basic science studies, which, in turn, informs the clinical to result in development of improved therapies for treatment of central nervous system conditions.

Keywords: Anesthetics; Cerebral autoregulation; Cerebral blood flow; Traumatic brain injury.

Figure 1

Comparison of proposed mechanisms for Phe (Upper Panel) and DA (Lower Panel) in control of cerebral hemodynamics after FPI in newborn piglets. Arrow thickness in proportion to probability of action. FPI = fluid percussion brain injury, ET-1 = endothelin-1, O2⁻ = oxygen free radical, ERK MAPK = Extracellular signal-regulated kinase (ERK) isoform of mitogen activated protein kinase (MAPK), Phe = phenylephrine, DA = dopamine, ADM = adrenomedullin, Katp and Kca = atp sensitive and calcium sensitive K channels. From Armstead WM, Vavilala, MS. Age and Sex Differences In Hemodynamics In a Large Animal Model of Brain Trauma. In: Lo EH, Lok J, Ning M, Whalen MJ, editors. Vascular Mechanisms in CNS Trauma. New York: Springer; 2014. p. 269–284; with permission.