Intracranial and spinal cord hemodynamics in the sitting position in dogs in the presence and absence of increased intracranial pressure.

The effect of the sitting position on cerebral blood flow (CBF), spinal cord blood flow (SCBF), and cerebral metabolic rate for oxygen (CMRo2) was studied in anesthetized dogs with and without increased intracranial pressure. Blood flow measurements were made at four time periods: (a) initial supine; (b) after 5 min in the sitting position; (c) after 60 min in the sitting position; and (d) 15 min after resuming the supine position. Six dogs (group 1) served as a control group with a normal intracranial pressure (ICP). In five dogs (group 2) ICP was elevated with a parietal epidural balloon 1 h before the first measurements of blood flows were made. Saline was injected incrementally into the balloon so as to reach a steady-state ICP of 30 mm Hg for 1 h. Elevation of ICP in group 2 resulted in significantly lower CBF, SCBF, and CMRo2 compared with group 1. Postural changes in group 1 did not result in any significant change in blood flow measurements whereas in group 2, after 1 h in the sitting position, there were significant decreases in CBF and SCBF compared with the initial supine measurements. There was, however, no corresponding decrease in CMRo2 in group 2 with change in position. These data suggest that both the brain and spinal cord may be at risk for ischemia during sitting position procedures under general anesthesia in the presence of elevated ICP.