Acta Neurochirurgica

, Volume 149, Issue 7, pp 691–698

Neurochemical monitoring using intracerebral microdialysis during systemic haemorrhage

  • P. Meybohm
  • E. Cavus
  • B. Bein
  • M. Steinfath
  • B. Weber
  • J. Scholz
  • V. Doerges
Experimental Research

DOI: 10.1007/s00701-007-1231-0

Cite this article as:
Meybohm, P., Cavus, E., Bein, B. et al. Acta Neurochir (Wien) (2007) 149: 691. doi:10.1007/s00701-007-1231-0
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Summary

Background. Intracerebral microdialysis is a sensitive tool to analyse tissue biochemistry, but the value of this technique to monitor cerebral metabolism during systemic haemorrhage is unknown. The present study was designed to assess changes of intracerebral microdialysis parameters both during systemic haemorrhage and after initiation of therapy.

Methods. Following approval of the Animal Investigational Committee, 18 healthy pigs underwent a penetrating liver trauma. Following haemodynamic decompensation, all animals received a hypertonic-hyperoncotic solution and either norepinephrine or arginine vasopressin, and bleeding was subsequently controlled. Extracellular cerebral concentrations of glucose (Glu), lactate (La), glycerol (Gly), and the lactate/pyruvate ratio (La/Py ratio) were assessed by microdialysis. Cerebral venous protein S-100B was determined. Haemodynamic data, blood gases, S-100B, and microdialysis variables were determined at baseline, at haemodynamic decompensation, and repeated after drug administration.

Results. Microdialysis measurements showed an increase of La, Gly, and La/Py ratio at BL Th compared to BL (mean ± SEM; La 2.4 ± 0.2 vs. 1.4 ± 0.2 mmol · l, p < 0.01; Gly 37 ± 7 vs. 27 ± 6 µmol · l, n.s.; La/Py ratio 50 ± 8 vs. 30 ± 4, p < 0.01), followed by a further increase during the therapy phase (La 3.4 ± 0.3 mmol · l; Gly 69 ± 10 µmol · l; La/Py ratio 58 ± 8; p < 0.001, respectively). Cerebral venous protein S-100B increased at decompensation and after therapy, but decreased close to baseline values after 90 min of therapy.

Conclusions. In this model of systemic haemorrhage, changes of cerebral energy metabolism detected by intracerebral microdialysis indicated anaerobic glycolysis and degradation of cellular membranes throughout the study period.

Keywords: Cerebral ischaemia; microdialysis; systemic haemorrhage; lactate

Abbreviations

art

arterial

CO

cardiac output

CPP

cerebral perfusion pressure

cv

cerebral venous

CVP

central venous pressure

FiO2

fraction of inspired oxygen

Glu

glucose

Gly

glycerol

ICP

intracranial pressure

La

lactate

La/Py ratio

lactate/pyruvate ratio

MAP

mean arterial blood pressure

p(cv-a)CO2

cerebral venous — arterial partial pressure difference of carbon dioxide

SjO2

jugular venous oxygen saturation

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • P. Meybohm
    • 1
  • E. Cavus
    • 1
  • B. Bein
    • 1
  • M. Steinfath
    • 1
  • B. Weber
    • 1
  • J. Scholz
    • 1
  • V. Doerges
    • 1
  1. 1.Department of Anaesthesiology and Intensive Care MedicineUniversity Hospital Schleswig-HolsteinCampus KielGermany