Cerebral perfusion monitored using transcranial Doppler during acute anaphylaxis

We present a case of severe acute anaphylaxis that occurred during preparat ion of a patient for carotid endarterectomy. Intra-arterial blood pressure and transcranial Doppler monitoring had been established before the anaphyl actic reaction began and therefore the changes in arterial blood pressure a nd middle cerebral artery blood-flow velocity could be observed as they hap pened. This made it possible to assess directly the effectiveness of our ma nagement, which followed the resuscitation guidelines issued by the Associa tion of Anaesthetists. In particular, this was a rare opportunity to confir m whether the recommended management is effective in restoring cerebral blo od flow and not just blood pressure, in a 'real life' situation, as most re suscitation information is based on laboratory-based animal studies. Eviden ce is presented which suggests that the administration of adrenaline in thi s setting is associated with increases in cerebral blood flow that are inde pendent of arterial blood pressure.