Lingzhong Meng, MD

Professor of Anesthesiology; Chief, Division of Neuro Anesthesia

Research Departments & Organizations

Anesthesiology

Faculty Research

Research Summary

Research related to Neuro Anesthesia, cerebral physiology, cerebral blood flow (CBF) regulation, tissue oxygenation monitoring and management, outcome improvement.

Extensive Research Description

Dr. Meng’s clinical research has been focusing on the following aspects.

Improving patient outcome via optimization of organ perfusion and tissue oxygenation. Organ ischemia & tissue hypoxia is one of the root causes of certain perioperative morbidities. Timely detection and correction of these mishaps contribute to an improved outcome. The first step of this query is the capacity to reliably monitor organ perfusion and tissue oxygenation. The advent of tissue oximetry based on near-infrared spectroscopy (NIRS) enables the clinician to monitor the balance between tissue oxygen consumption and supply continuously and non-invasively at the patient’s bedside. Research has been done to understand how the perioperative factors/interventions affect cerebral oxygenation monitored using NIRS. Investigation has also been done to understand how intraoperative tissue oxygenation of different tissue beds, e.g. cerebral tissue vs. muscular tissue, is associated with postoperative outcomes. Yet, the fundamental step of this query is to test if tissue oxygenation – guided care improves the outcomes that matter most to patients. Even though outcome research has been done previously, various methodological limitations exist. The future research should address the definition of an individual patient’s baseline value that is associated with a beneficial outcome, the threshold for intervention, and the patient populations that benefit from tissue oxygenation – guided care.

Improving patient outcome via choosing the appropriate anesthetic technique. The aspects of anesthetic technique include, but not limited to, monitored anesthesia care vs. general anesthesia, laryngeal mask airway vs. endotracheal tube, volatile vs. intravenous agents, the strategies of hemodynamic management, and the modes and settings of mechanical ventilation, etc. The available evidence has suggested an association between a specific aspect of anesthetic technique and patient outcome. However, due to the multiplicity of the aspects of the anesthetic technique and the complexity of randomized controlled trial in clinical setting, much work is needed to better understand the effect of different anesthetic management on patient outcome.

Activities

  • Yale New Haven Hospital New Haven, United States (2016)

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Contact Info

Lingzhong Meng, MD
Mailing Address
Yale Department of Anesthesiology
333 Cedar Street, TMP 3

New Haven, CT 06520
Effect of phenylephrine and ephedrine bolus treatment on blood pressure, cardiac output, and cerebral oxygenation

Following phenylephrine administration, even though blood pressure is increased, both cardiac output and cerebral oxygenation are decreased. In contrast, both cardiac output and cerebral oxygenation are maintained after ephedrine administration which also leads to an increase of blood pressure. It implies that different vasoactive drugs exert different impacts on systemic circulation and organ perfusion/oxygenation. The mechanisms behind these observations have been explored and the clinical significance awaits to be determined. Meng L, Cannesson M, Alexander BS, Yu Z, Kain ZN, Cerussi AE, Tromberg BJ, Mantulin WW. Effect of phenylephrine and ephedrine bolus treatment on cerebral oxygenation in anaesthetized patients. Br J Anaesth. 2011;107:209-17.

Integrated multifactorial CBF regulation

"The proposed conceptualization integrating various CBF-regulating mechanisms within the framework of cerebral autoregulation has important clinical implications. The habitual thinking that how the brain is perfused is merely dependent on the blood pressure should be abandoned. The autoregulatory curve should be regarded as a dynamic process, meaning that its shape, plateau, and the lower and upper limits may change depending on the integrated effect of nonpressure but CBF-regulating mechanisms including the CO. For a given value of blood pressure, even though it is deemed clinically acceptable, the CBF may be either higher or lower than that estimated by the traditional autoregulatory curve. Therefore, the management of CBF should be guided by a multifactorial but integrated framework of CBF regulation, especially in patients who are at risk of cerebral ischemia." Meng L, Hou W, Chui J, Han R, Gelb AW. Cardiac Output and Cerebral Blood Flow: The Integrated Regulation of Brain Perfusion in Adult Humans. Anesthesiology. 2015;123:1198-208.