Brain BOLD MRI O2 and CO2 stress testing: Implications for perioperative neurocognitive disorder following surgery

Abstract

Respiratory end-tidal (ET) gas control is fundamental to anaesthetic management. The range of ET O2 and CO2 during the conduct of anaesthesia can significantly deviate from values in the awake state. Recent work shows ET CO2 influences the incidence of perioperative neurocognitive disorder (POND). We examine the effects of controlled alterations in both ET O2 and CO2 on cerebral blood flow (CBF) in awake adults using BOLD MRI. Twelve healthy adults had BOLD and CBF responses measured to alterations in ET CO2 and O2 in various combinations commonly observed under anaesthesia. Dynamic alterations in regional BOLD and CBF were seen in all subjects with expected and inverse responses to both stimuli. These effects were incremental and rapid (within seconds). The most dramatic effects were seen with combined hyperoxia and hypocapnia. Inverse responses increased with age. Here we show that human brain CBF responds dramatically to alterations in ET respiratory gas tensions commonly seen during anaesthesia. Such alterations may impact the observed incidence of POND following surgery and intensive care, and is an important area for further investigation.