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Cerebral perfusion and metabolism after profound hypothermia—comparison between procedures involving no flow and low flow

Published online by Cambridge University Press:  19 August 2008

Rolf Ekroth ,
Jan van der Linden ,
Christopher Lincoln  and
Michael Scallan
Rolf Ekroth
Affiliation:
From the Departments of Thoracic and Cardiovascular Surgery
Jan van der Linden
Affiliation:
Anesthesia and Intensive Care
Christopher Lincoln*
Affiliation:
Sahlgrenska Hospital, Gothenburg, and the Departments of Cardiothoracic Surgery
Michael Scallan
Affiliation:
Anaesthesia, Royal Brompton National Heart & Lung Hospital, London
*
Mr. Christopher Lincoln, Department of Cardiothoracic Surgery, Royal Brompton National Heart and Lung Hospital, Sydney Street, London SW3 6NP, United Kingdom.
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Extract

The debate concerning no flow versus low flow continues. Thus, it has not yet been possible to conclude whether limited period of total circulatory arrest, as opposed to maintained but reduced systemic flow, offers superior protection of the brain during cardiac surgery in children. While most previous work has focused on the hypothermic period of no versus low flow, less is known about the conditions during and after rewarming with full systemic flow. Some previous data, which related the ischemic marker creatine kinase BB during profound hypothermic procedures, suggested that neural dysfunction was aggravated by posthypothermic factors such as hyperglycemia, acidosis and anemia.

Keywords

Pediatric anesthesiabrain blood flowbrain metabolismcardiac surgery
Type
World Forum for Pediatric Cardiology Symposium on Cardiopulmonary Bypass (Part 2)
Information
Cardiology in the Young , Volume 3 , Issue 4 , October 1993 , pp. 378 - 382
Copyright
Copyright © Cambridge University Press 1993

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References

1.Ekroth, R, Thompson, RJ, Lincoln, C, Scallan, M, Rossi, R, Tsang, V. Elective deep hypothermia with total circulatory arrest. Changes in plasma CK-BB, Blood glucose and clinical variables. J Thorac Cardiovasc Surg 1989; 97: 30–35.CrossRefGoogle Scholar
2.Wells, FC, Coghill, S, Caplan, HL, Lincoln, C. Duration of circulatory arrest does influence the psychological development of children after cardiac operations in early life. J Thorac Cardiovasc Surg 1983; 86: 823–831.CrossRefGoogle ScholarPubMed
3.Rossi, R, Ekroth, R, Lincoln, C, Jackson, A, Thompson, R, Scallan, M, Lincoln, C. Detection of cerebral injury after total circulatory arrest and profound hypothermia by estimation of specific creatine kinase isoenzyme levels using monoclonal antibody techniques. Am J Cardiol 1986; 58: 1236–1241.CrossRefGoogle ScholarPubMed
4.Molina, JE, Einzig, S, Angeline, RM, Bianco, RW, Marks, JA, Rasmussen, TM. Brain damage in profound hypothermia. Perfusion versus circulatory arrest. J Thorac Cardiovasc Surg 1984; 87: 596–604.CrossRefGoogle ScholarPubMed
5.Rossi, R, van der Linden, J, Ekroth, R, Scallan, M, Thompson, RJ, Lincoln, C. Total circulatory arrest or maintained perfu sion reduced to 25%; A study of the brain specific ischemic market CK-BB after deep hypothermic procedures. J Thorac Cardiovasc Surg 1989; 98: 193–199.CrossRefGoogle ScholarPubMed
6.van der Linden, J, Priddy, R, Ekroth, R, Lincoln, C, Pugsley, W, Scallan, M, Tyden, H. Cerebral perfusion and metabolism during profound hypothermia in children. A study of middle cerebral artery ultrasonic variables and cerebral extraction of oxygen. J Thor Cardiovasc Surg 1991; 102: 103–114.CrossRefGoogle ScholarPubMed
7.van der Linden, J, Ekroth, R, Lincoln, C, Pugsley, W, Scallan, M, Tyden, H. Is cerebral blood flow/metabolic mismatch during rewarming a risk factor after profound hypothermic proce dures in small children? EurJ Cardiothorac Surg 1989; 3: 209–215.CrossRefGoogle Scholar
8.Watanabe, T, Orita, H, Kobayashi, M, Washio, M. Brain tissue pH, oxygen tension and carbon dioxide in profoundly hypo thermic cardiopulmonary bypass. J Thorac Cardiovasc Surg 1989; 97: 396–401.CrossRefGoogle Scholar
9.Swain, JA, McDonald, TJ, Griffith, PK, Balaban, RS, Clark, RE, Ceckler, T. Low-flow hypothermic cardiopulmonary bypass protects the brain. J Thorac Cardiovasc Surg 1991; 102: 76–84.CrossRefGoogle ScholarPubMed
10.Scheller, MS, Branson, PJ, Cornacchia, LG, Alksne, JF. A comparison of the effects on neuronal Golgi morphology, assessed with electron microscopy, of cardiopulmonary by-pass, low-flow bypass, and circulatory arrest during profound hypothermia. J Thorac Cardiovasc Surg 1992; 104: 1396–1404.CrossRefGoogle Scholar
11.Astudillo, R, van der Linden, J, Ekroth, R, Wesslen, O, Hallhagen, S, Lincoln, C, Scallan, M, Shore, D. Absent diastolic cerebral blood flow velocity after circulatory arrest, but not after low-flow in infants. Ann Thorac Surg. [In press]Google Scholar
12.Burrows, FA, Hillier, SC, Mcleod, ME, Iron, KS, Taylor, MJ. Anterior fontanel pressure and visually evoked potentials in neonates arid infants undergoing profound hyporhermic pro cedures. Anesthesiology 1990; 73: 632–636.CrossRefGoogle Scholar
13.Greeley, WJUngerleider, RM, Smith, L, Reves, JG. The effects of deep hypothermic cardiopulmonary bypass and total circu latory arrest on cerebral blood flow in infants and children. J Thorac Cardiovasc Surg 1989; 97: 737–745.CrossRefGoogle Scholar
14.Greeley, WJ, Kern, FH, Ungerleider, RM, Boyd, JL, Quill, T, Smith, LR, Baldwin, B, Reves, JG. The effect of hypothermic cardiopulmonary bypass and total circulatory arrest on cere bral metabolism in neonates, infants and children. J Thorac Cardiovasc Surg 1991; 101: 783–794.CrossRefGoogle Scholar
15.Settergren, G, Oquist, G, Lundberg, S, Henze, A, Bjork, VO, Persson, B. Cerebral blood flow and cerebral metabolism in children following cardiac surgery with deep hypothermia and circulatory arrest. Scand J Cardiovasc Surg 1982; 16: 209–215.Google ScholarPubMed
16.Hillier, SC, Burrows, SA, Bissonnette, B, Taylor, RH. Cerebral hemodynamics in neonates and infants undergoing cardiopul monary bypass and profound hypothermic cardiac arrest: assessment by transcranial Doppler sonography. Anesth Analg 1991; 2: 723–728.Google Scholar
17.Rosenkranz, ER, Okamoto, F, Buckberg, GD, Robertson, JM, Vinten-Johansen, J, Bugyi, HI. Safety of prolonged aortic clamping with blood cardioplegia. III. Aspartate enrichment of glutamate-blood cardioplegia in energy-depleted hearts after ischemic and reperfusion injury. J Thorac Cardiovasc Surg 1986; 91: 428–435.CrossRefGoogle ScholarPubMed
18.Taylor, RH, Burrows, FA, Bissonnette, B. Cerebral pressure flow velocity relationship during hypothermic cardiopulmonary bypass in neonates and infants. Anesth Analg 1992; 74: 636–642.CrossRefGoogle ScholarPubMed