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April 1995

In Search of a Safe Apnea Test in Brain Death: Is the Procedure Really More Dangerous Than We Think?

Author Affiliations

Neurological-Neurosurgical Intensive Care Unit Mayo Clinic 200 First St SW Rochester, MN 55905

Arch Neurol. 1995;52(4):338. doi:10.1001/archneur.1995.00540280018005

Maintaining a minimum systolic blood pressure of 90 mm Hg ensures adequate perfusion to all vital organs that may potentially be used for donation. That hypotension develops during apnea testing in certain patients who otherwise fulfill the clinical criteria of brain death is well recognized. Causes of hypotension in brain death may be related to cardiac arrhythmias, cardiac stunning, diabetes insipidus, prior use of diuretics and fluid restriction in the management of primary brain injury, or loss of arterial and venous sympathetic tone as a result of destruction of the pontine and medullary vasomotor structures.1

Neurologists do not like to perform apnea testing, and they do it in an inappropriate manner. In a survey of neurologists in Colorado and California, Earnest et al2 found that only one of eight neurologists vigorously performed apnea testing by providing 100% oxygen during testing and by measuring arterial blood gas levels. One

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