BJA Advance Access originally published online on June 25, 2004
British Journal of Anaesthesia 2004 93(5):710-724; doi:10.1093/bja/aeh205
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2004
Transcranial Doppler ultrasonography in anaesthesia and intensive care
University of Nottingham, Division of Anaesthesia and Intensive Care, Departments of Anaesthesia and Intensive Care, 1 Queen's Medical Centre and 2 City Hospital, Nottingham, UK
* Corresponding author. E-mail: iain.moppett@nottingham.ac.uk
Keywords: monitoring, intensive care; monitoring, transcranial Doppler ultrasonography
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Introduction |
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Transcranial Doppler ultrasonography (TCD) was introduced in 1982 by Aaslid and colleagues5 as a non-invasive technique for monitoring blood flow velocity (FV) in the basal cerebral arteries. It is now increasingly being used in anaesthesia and intensive care for research as well as in clinical practice. The purpose of this review is to present: the basic concepts of TCD; the current status of the information obtained; its use of assessment of vascular reactivity; and applications in anaesthesia and intensive care.
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Basic concepts |
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TCD is based on the use of a range-gated, pulsed-Doppler ultrasonic beam of 2 MHz frequency.5 The ultrasonic beam crosses the intact skull at points known as ‘windows’ and is reflected back from the moving erythrocytes in its path. The difference between the transmitted signal and the received signal is called the Doppler shift, and can be expressed by the formula:1
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Information obtained using TCD |
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Technique
Blood FV
Measures of cerebrovascular resistance
Measures of vessel diameter
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Limitations of TCD |
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FV vs blood flow
Angle of insonation
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Acoustic window |
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Comparison of TCD with other techniques of assessing CBF |
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Advantages of TCD over other estimates of CBF |
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Cerebral vascular reactivity |
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Measurement of cerebral autoregulation using TCD
Static autoregulation
Dynamic autoregulation
Transient hyperaemic response (THR) test
Other methods
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Carbon dioxide reactivity |
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Non-invasive estimation of CPP and zero flow pressure |
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Detection of emboli |
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Applications of TCD in intensive care |
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Head injury
Subarachnoid haemorrhage
Liver failure
Brain stem death
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Applications of TCD in anaesthesia |
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Neurosurgery
Carotid endarterectomy
Cardiac surgery
Obstetrics
Anaesthetic agents
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Future developments |
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