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Cerebral Blood Flow During Flexion and Rotation of the Cervical Spine (TCDPOS)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT02152488
Recruitment Status : Completed
First Posted : June 2, 2014
Last Update Posted : June 2, 2014
Information provided by (Responsible Party):
Axel Fudickar, University of Schleswig-Holstein

Brief Summary:

Rotation or flexion of the cervical spine is unavoidable during positioning for some surgical procedures as carotid endarterectomy, thyroidectomy and surgery of the shoulder. Rotation or flexion may reduce blood flow in the carotid or vertebral arteries and induce intraoperative cerebral ischemia with impact on the neurological outcome of surgery. Predominantly if the circulus willisii is incomplete because of congenital variation, collateral arteries may not be sufficient to compensate reduced blood flow in one carotid or vertebral artery. This may be aggravated by intraoperative hypotension in limits tolerable under normal conditions but fatal during impairment of vascular conductivity by positioning. The middle cerebral artery (MCA) is a final large scale pathway of cerebral blood flow and hence relevant reduction of flow in the MCA may serve as a surrogate parameter for relevant reduction of cerebral blood flow caused by carotid stretching or narrowing.

Objective of this study is to investigate, if MCA blood flow in normal male and female subjects, aged 18 to 85 years, is reduced in extended and rotated cervical spine position in comparison to neutral position.

Condition or disease
Functional Blood Flow Disorder

Detailed Description:
Blood flow in the middle cerebral artery (MCA) was measured bilaterally using a bidirectional multigate 2Mhz pulsed wave Transcranial Doppler (Multidop T1, Software Multiflow MF version 8.27j, DWL Corp., Sipplingen, Germany). Using a trans-temporal approach to the proximal segment (M1) of the MCA, the Doppler probes were fixed bilaterally with an adjustable mounting (SPENCER helmet) to keep the angle and depth of insonation constant over time. With the upper cervical spine in a neutral sagittal orientation, the insonation depth was chosen between 45 and 55 mm and the point permitting best recording was fixed. A sample volume of 5 mm, a sonographic frequency of 128 Hz FFT, and a fast sweep for temporal overlap were determined. Low power and low gain was set within the dynamic range of the system. All measurements were performed between 10:00 AM and 2:00 PM, by the same examiner (JL) in a quiet, warm, well-lit room. Each subject was asked to assume a relaxed, supine position. Patients eyes were closed to eliminate stimulation of the occipital cortex. Three minutes rest were provided to acclimatize and stabilize haemodynamically. Non-invasive blood pressure was measured at both arms before and after the procedure to ensure that any possible changes in blood flow were not related to blood pressure changes. The time-averaged mean blood flow velocities on both sides were measured with the cervical spine in neutral position, rotated maximally to the left, then to the right, hyperextended and then hyperextended and rotated to the left and to the right position. Measurements were performed after 1 min of stable blood flow. Neutral position was reestablished after each position and next maneuver started after blood velocities in neutral position had normalized to velocities in starting neutral position.

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Study Type : Observational
Actual Enrollment : 80 participants
Observational Model: Case-Crossover
Time Perspective: Prospective
Official Title: Cerebral Blood Flow During Flexion and Rotation of the Cervical Spine
Study Start Date : March 2010
Actual Primary Completion Date : April 2010
Actual Study Completion Date : April 2010

Resource links provided by the National Library of Medicine

Primary Outcome Measures :
  1. Blood flow in middle cerebral artery during rotation of the cervical spine [ Time Frame: From measurement of baseline blood flow until measurement of blood flow during rotation to the right and hyperextension of the cervical spine up to 1 hour ]
    Blood flow in the middle cerebral artery (MCA) was measured bilaterally using a bidirectional multigate 2Mhz pulsed wave Transcranial Doppler in normal and rotated position of the cervical spine.

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
80 patients presenting in the pre-anaesthesia ambulance of the University Hospital Schleswig-Holstein, Campus Kiel were enrolled in the study. Exclusion criteria were cranial spine pathology and known cerebral vascular disease.

Inclusion Criteria:

  • Patients presenting ambulant for preoperative evaluation for routine surgery.

Exclusion Criteria:

  • Cranial spine pathology and cerebral vascular disease.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT02152488

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University Hospital Schleswig-Holstein, Campus Kiel
Kiel, Schleswig-Holstein, Germany, 24105
Sponsors and Collaborators
University of Schleswig-Holstein
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Principal Investigator: Axel Fudickar, Dr. University Hospital Schleswig-Holstein, Campus Kiel
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Responsible Party: Axel Fudickar, Dr. med., University of Schleswig-Holstein Identifier: NCT02152488    
Other Study ID Numbers: Fudickar4
First Posted: June 2, 2014    Key Record Dates
Last Update Posted: June 2, 2014
Last Verified: May 2014
Keywords provided by Axel Fudickar, University of Schleswig-Holstein:
cerebral blood flow
cervical spine