| Cerebral protection using retrograde cerebral perfusion during hypothermic circulatory arrest. | |
| | |
MedLine Citation:
|
PMID: 9350371 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: Retrograde cerebral perfusion through the superior vena cava (SVC) has been proposed to protect the brain from ischaemic injury during profound hypothermic circulatory arrest (PHCA). Its contribution to cerebral protection is unclear. Furthermore, the addition of anaesthetic or vasodilating agents to the SVC perfusate to enhance brain protection, has never been described. METHODS: In three patients undergoing repair of the ascending aorta utilizing PHCA, the upper body was retrogradely perfused with cold (16 degrees C) blood through the SVC by the cardiopulmonary bypass pump. Electroencephalographic activity was monitored using a computerized electroencephalographic monitor (Cerebro Trac 2500, SRD). Perfusion pressure was measured at a port in the cannula connector. Etomidate or thiopentone was injected into the SVC perfusate to arrest reappearing electroencephalographic activity. Nitroglycerin or nitroprusside was injected into the perfusate to increase retrograde flow and maintain a constant perfusion pressure. RESULTS: During PHCA periods of up to 61 min, recurrent electroencephalographic activity was abolished by the retrograde administration of small boluses of etomidate (total 50 mg) or thiopentone (total 500 mg). Nitroprusside (100 micrograms) and nitroglycerin (2 micrograms.kg-1.min-1) increased retrograde flow from 220 to 550 and 660 ml.min-1, respectively, while maintaining perfusion pressure (25-26 mmHg). Recovery from anaesthesia and surgery was uneventful, with no adverse neurological sequelae. CONCLUSION: Injection of anaesthetic agents into the retrograde SVC perfusate during PHCA, can suppress reoccurring electroencephalographic activity and retrograde injection of vasodilators can facilitate an increase in perfusion. It is suggested that both may augment brain protection. |
| | |
Authors:
|
Z Shenkman; A Elami; Y G Weiss; L Glantz; E Milgalter; B Drenger; F A Burrows; Y Shir |
Publication Detail:
|
Type: Case Reports; Journal Article |
Journal Detail:
|
Title: Canadian journal of anaesthesia = Journal canadien d'anesthésie Volume: 44 ISSN: 0832-610X ISO Abbreviation: Can J Anaesth Publication Date: 1997 Oct |
Date Detail:
|
Created Date: 1997-12-04 Completed Date: 1997-12-04 Revised Date: 2004-11-17 |
Medline Journal Info:
|
Nlm Unique ID: 8701709 Medline TA: Can J Anaesth Country: CANADA |
Other Details:
|
Languages: eng Pagination: 1096-101 Citation Subset: IM |
Affiliation:
|
Department of Anesthesiology & CCM, Hadassah University Hospital, Jerusalem, Israel. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Aged Anesthesia, Intravenous* Anesthetics, Intravenous / administration & dosage, therapeutic use Brain Ischemia / prevention & control* Electrocardiography Electroencephalography Etomidate / administration & dosage, therapeutic use Heart Arrest, Induced* Humans Hypothermia, Induced* Male Middle Aged Nitroglycerin / therapeutic use Nitroprusside / therapeutic use Perfusion* Thiopental / administration & dosage, therapeutic use Vasodilator Agents / administration & dosage, therapeutic use Vena Cava, Superior / physiology |
| Chemical | |
Reg. No./Substance:
|
0/Anesthetics, Intravenous; 0/Vasodilator Agents; 15078-28-1/Nitroprusside; 33125-97-2/Etomidate; 55-63-0/Nitroglycerin; 76-75-5/Thiopental |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Anaesthetic management of a patient with Leigh's syndrome.
Next Document: Venous gas embolism--a comparison of carbon dioxide and helium in pigs.