Document Detail


Extracellular lactate/pyruvate and glutamate changes in patients during per-operative episodes of cerebral ischaemia.
MedLine Citation:
PMID:  12168348     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Temporary Internal Carotid Artery (ICA) clipping necessary during aneurysm surgery was used as a model to investigate metabolic changes in the human brain during defined episodes of ischaemia. DESIGN: An observational study using intracerebral monitors: PBO2 (Neurotrend) and microdialysis (CMA, Sweden). SUBJECTS: 16 patients monitored during complex aneurysm surgery. OUTCOME MEASURES: Changes in extracellular concentrations of glucose, lactate, and glutamate and lactate/pyruvate ratio (L/P). RESULTS: Mean age was 55. 10 patients presented with subarachnoid haemorrhage and 6 with mass effect (4 giant). Temporary ICA occlusion was required for dissection (n = 9), intraoperative rupture (n = 5) or aneurysmal thrombectomy (n = 2). The mean total duration was 15 minutes (range 4-52 minutes). No infarcts developed in the monitored regions. Microdialysis was unsuccessful in 3 patients and Neurotrend in 1. Patients were grouped according to the degree and duration of fall in PBO2: minimal brief falls were not associated with microdialysis changes (n = 5). More pronounced falls were associated with increases in L/P (n = 4). Only prolonged occlusions averaging 42 minutes (n = 3) with PBO2 sustained below 1 kPa were associated with rises in glutamate. CONCLUSIONS: Brief temporary ICA occlusion caused an initial increased L/P. Glutamate increases were only seen after occlusion that was prolonged with PBO2 below 1.0 kPa.
Authors:
R Kett-White; P J A Hutchinson; P G al-Rawi; A K Gupta; M T O'Connell; J D Pickard; P J Kirkpatrick
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Acta neurochirurgica. Supplement     Volume:  81     ISSN:  0065-1419     ISO Abbreviation:  Acta Neurochir. Suppl.     Publication Date:  2002  
Date Detail:
Created Date:  2002-08-09     Completed Date:  2003-01-21     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  100962752     Medline TA:  Acta Neurochir Suppl     Country:  Austria    
Other Details:
Languages:  eng     Pagination:  363-5     Citation Subset:  IM    
Affiliation:
Academic Department of Neurosurgery, Wolfson Brain Imaging Centre, Addenbrooke's Hospital, Cambridge, UK.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Biological Markers
Brain / metabolism*
Brain Ischemia / etiology,  metabolism*
Carotid Artery, Internal / surgery*
Craniotomy
Glutamic Acid / metabolism*
Humans
Intracranial Aneurysm / surgery*
Lactic Acid / metabolism*
Middle Aged
Monitoring, Intraoperative / methods
Neurosurgical Procedures / methods
Pyruvic Acid / metabolism*
Time Factors
Chemical
Reg. No./Substance:
0/Biological Markers; 127-17-3/Pyruvic Acid; 50-21-5/Lactic Acid; 56-86-0/Glutamic Acid

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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