Related Experiment Video
Updated: May 19, 2026
Point of Care Transcranial Color-Coded Duplex Ultrasound of the Middle Cerebral Artery
Published on: August 9, 2024
Transcranial Doppler sonography as a potential screening tool for preanaesthetic evaluation: a prospective
Axel Fudickar1, Joern Leiendecker, Anna Köhling
1Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg, Germany. axel.fudickar@uksh.de
Context:
Intraoperative cervical spine rotation may compromise cerebral blood flow in susceptible individuals by distortion of cervical arteries.
Objective:
To investigate the effect of five cervical spine positions on cerebral blood flow in the middle cerebral artery.
Design:
Prospective observational study.
Setting:
University hospital.
Patients:
Fifty-six male and 24 female patients scheduled for general anaesthesia for routine surgery. Exclusion criteria were cranial spine pathology and cerebral vascular disease.
Interventions:
Maximum rotation of the head to the left and right side with and without hyperextension, and hyperextension in the neutral position.
Main Outcome Measures:
Change of mean blood flow velocity in the middle cerebral artery measured by transcranial Doppler sonography.
Results:
Age had a significant effect on mean blood flow velocity in the left middle cerebral artery in the neutral position (P = 0.047). There was a significant difference in mean blood flow velocity in the left middle cerebral artery between patients younger than 40 years and patients older than 59 years [61.2 (16.6) ml min(-1) vs. 47.7 (16.2) ml min(-1); P = 0.015]. There was a significant effect of head position on mean blood flow velocity in both the left and in the right middle cerebral arteries (P = 0.039 left, P = 0.025 right). Twenty patients had a decrease of more than 20% from their baseline mean blood flow velocity.
Conclusion:
Neck rotation and/or extension resulted in a significant change of blood flow in the middle cerebral artery.
