CEREBRAL PHYSIOLOGY

Presentor- Dr Soumyasri Ambli

Moderater- Dr Abhinay Jain
Contents
 Anatomy of Cerebral Circulation
 Cerebral Blood flow
 Cerebra Metabolic Rate
 Effects of Anaesthetic Drugs on CBF & CMR
 CSF Dynamics
Cerebral Circulation
Cerebral Blood Flow
 Brain weighs 1350g(2% of body weight)
 Receives 12% to 15% of CO

CBF

Global 45-55 ml/100gm/min

cortical 75-80 ml/100gm/min

subcortical 20ml/100gm/min
Regulation of CBF
1.Chemical factors
• CMR
• PaO2
• PaCO2

2.Myogenic factors
• Autoregulation
• Rheologic

3.Neurogenic factors
Chemical factors
Cerebral metabolic rate:
• Increased neuronal activity results in local brain

metabolism and this increase in CMR is associated

with a proportional change in CBF, this is termed as
“flow-metabolism coupling”
• This is due increased local byproducts of metabolism

which affect vascular tone

• Glutamate results in synthesis and release of NO, a

potent vasodilator also plays a role in flow

metabolism coupling
• CMR is influenced by several factors like functional

status of brain, anesthetic drugs & temperature.

CMR..
Functional state: decreases during seep,
increased during mental tasks,sensory
stimulation
Temperature: CMR decreases by 6% to 7% per
deg celsius reduction of temperature
Anesthetic drugs: supress the CMR with
exception of ketamine & N2O
PaCO2 & PaO2
PaCO2
• CBF varies directly with PaCO2 in physiologic

range
• 1mm hg variation in paco2 results in 1-2

ml/100gm/min variation in CBF

PaO2
• Between 60-300mmhg variation in CBF is little

• When <60mmhg CBF increases rapidly,

vasodilatation is by peripheral & central

chemoreceptors as well as local influences
Myogenic factors
 Myogenic regulation(autoregulation): capacity
of the cerebral vasculature to adjust its
resistance to maintain constant CBF over wide
range of MAP(70-150mmhg)
 Changes in CPP(MAP-ICP) lead to direct

changes in the tone of vascular smooth

muscle
 Autonomic innervation also contribute to the

autoregulation
Neurogenic factors
 Cerebral vasculature is heavily innervated,
density of innervation decreases with vessel
size
 Innervation includes cholinergic, adrenergic,

sertoninergic & VIPergic systems

 Sympathetic decreases CBF
 Parasympathetic increases CBF
Blood Viscosity
 Hematocrit is important determinant in blood
viscosity
 There is not much variation in physiologic

range(33%-45%)
 In anemia vasculature resistance is reduced &

CBF increases
Effect of anaesthetic drugs
Intravenous anaesthetic drugs
 Most intravenous anaesthetics leads to

parallel reductions in CMR & CBF. Ketamine

causes increase in CBF & CMR, is the
exception.
Barbiturates
 Dose dependant reduction in CBF & CMR
occurs with barbiturates
 With onset onset of anaesthesia, both CBF &

CMR reduces by 30%

 Large dose of thiopental cause complete EEG

suppression, CBF & CMR reduces by 50%

 Further increase in dose have no additional

effect
Propofol
 CBF is reduced by 53% to 79% in surgical
levels of propofol compared to awake state
 CMR decreases by 48-58%
 Also decreases CBV & ICP
 Both CO2 responsiveness & autoregulation

are preserved
Etomidate
 Effects of etomidate on CBF & CMR are similar
to those of barbiturates
 Etomidate is effective in reducing ICP without

causing a reduction in CPP in patients with

head injuries
 Reactivity to CO2is preserved
Ketamine
 Increases both CBF & CMR
 Increase in CMR is greatest in frontal & ant

cingulate cortex
 Autoreglation & CO2 responsiveness is

preserved
Inhaled Anaesthetics
 All volatile anaesthetics suppress cerebral
metabolism in dose related manner
 Volatile anesthetics have intrinsic vasodilatory
effect on vascular smooth muscle
 Vasodilatation with increasing doses leads to
attenuation of cerebral autoregulaion
 Vasodilating potency: halothane>
enflurane>desflurane=isoflurane>sevofluran
 CO2 responsiveness is well maintained with all VA
 Autoregulation of CBF is impaired
N2O
 Increases CBF,CMR & ICP
 When N2O is administered alone very

substantial increase in CBF & ICP occur

Muscle relaxants
 Non depolarising relaxants:
• Histamine can result in a reduction in CPP

because of simultaneous increase in ICP &

decrease in MAP
• A metabolite of atracurium, laudanosine may be

epileptogenic
 Succinylcholine

• produces increase in ICP

• This effect is a result of cerebral activation caused

by afferent activity from muscle spindle apparatus

CSF Dynamics
 CSF in adult-150ml,one half in cranium & one
half in spinal cord
 Replaced 3-4 times per day(21ml/day)
 Functions both as cushion for CNS & as an

excretory pathway
Thank you.