Cerebral perfusion monitored using transcranial Doppler during acute anaphylaxis.

Abstract

We present a case of severe acute anaphylaxis that occurred during preparation of a patient for carotid endarterectomy. Intra-arterial blood pressure and transcranial Doppler monitoring had been established before the anaphylactic reaction began and therefore the changes in arterial blood pressure and middle cerebral artery blood-flow velocity could be observed as they happened. This made it possible to assess directly the effectiveness of our management, which followed the resuscitation guidelines issued by the Association of Anaesthetists. In particular, this was a rare opportunity to confirm whether the recommended management is effective in restoring cerebral blood flow, and not just blood pressure, in a 'real life' situation, as most resuscitation information is based on laboratory-based animal studies. Evidence is presented which suggests that the administration of adrenaline in this setting is associated with increases in cerebral blood flow that are independent of arterial blood pressure.