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Cerebral Hyperperfusion During Cardiopulmonary Bypass: The Influence of PaCO2

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Brain Injury and Protection During Heart Surgery

Abstract

During cardiac surgery, many institutions routinely cool patients to a core temperature between 25° to 30°C. Systemic hypothermia augments topical cooling and cardioplegia by further delaying myocardial rewarming, thus increasing the tolerance of the heart to cross-clamp induced ischemia. Acid-base and ventilatory management during hypothermic cardiopulmonary bypass (CPB) are controversial [1,2] as are many other facets of CPB including the use of pulsatile or nonpulsatile perfusion, membrane versus bubble oxygenators, selection of appropriate pump flow, and even the determination of adequate perfusion pressure during CPB. Recent studies have begun to address some of these issues, yet the results obtained appear contradictory.

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References

  1. Ream AK, Reitz BA, Silverberg G: (1982) Temperature correction of pCO2 and pH in estimating acid-base status: an example of the emperor’s new clothes? Anesthesiology 56: 41–44.

    Article  PubMed  CAS  Google Scholar 

  2. Williams JJ, Marshall BE: (1982) A fresh look at an old question. Anesthesiology 56:1–2.

    Article  PubMed  CAS  Google Scholar 

  3. Govier ASAV, Reves JG, McKay RD, Karp RB, Zorn G, Morawetz RB, Smith LR, Adams M, Freeman AM: (1984) Factors and their influence or regional cerebral blood flow during nonpulsatile cardiopulmonary bypass. Ann Thorac Surg 38:592–600.

    Article  PubMed  CAS  Google Scholar 

  4. Henriksen L, Hjelms E, Lindeburg T: (1983) Brain hyperperfusion during cardiac operations. J Thorac Cardiovasc Surg 86:202–208.

    PubMed  CAS  Google Scholar 

  5. Wilson TL: (1977) Theoretical analysis of the effects of two pH regulation patterns on the temperature sensitivities of biological systems in nonhomeothermic animals. Arch Biochem Biophys 182:409–419.

    Article  PubMed  CAS  Google Scholar 

  6. Howell BJ, Baumgardner FW, Bondi K, Rahn H: (1970) Acid-base balance in cold-blooded vertebrates as a function of body temperature. Am J Physiol 218:600–606.

    PubMed  CAS  Google Scholar 

  7. Rahn H, Reeves RB, Howell BJ: (1975) Hydrogen ion regulation, temperature and evolution. Am Rev Resp Dis 112:165–172.

    PubMed  CAS  Google Scholar 

  8. White FN: (1981) A comparative physiological approach to hypothermia. J Thorac Cardiovasc Surg 82:821–831.

    PubMed  CAS  Google Scholar 

  9. Reeves RB: (1972) An imidazole alphastat hypothesis for vertebrate acid-base regulation: Tissue carbon dioxide content and body temperature in bullfrogs. Respir Physiol 14:219–236.

    Article  PubMed  CAS  Google Scholar 

  10. Swan H: (1984) The importance of acid-base management for cardiac and cerebral preservation during open heart operations. Surg Gynecol Obst 158:391–414.

    CAS  Google Scholar 

  11. Reeves RB: (1976) Temperature induced changes in blood acid-base status, DonnanrCl and red cell colume. J Appl Physiol 40:762–767.

    PubMed  CAS  Google Scholar 

  12. Kety SS, Schmidt CF: (1947) The nitrous oxide method for the quantitative determination of cerebral blood flow in man: Theory, procedure and normal values. J Clin Invest 27:476–483.

    Article  Google Scholar 

  13. Austin G, Horn N, Rouhe S, Hayward W: (1972) Description and early results of an intravenous radioisotope technique for measuring regional cerebral blood flow in man. Europ Neurol 8:43–51.

    Article  PubMed  CAS  Google Scholar 

  14. Harper AM, Glass HI, Steven JL, et al: (1964) The measurement of local blood flow in the cerebral cortex from the clearance of xenon133. J Neurol Neurosurg Psychiat 27:255–258.

    Article  PubMed  CAS  Google Scholar 

  15. Murkin JM, Farrar JK, Tweed WA, McKenzie FN, Guiraudon GM: (1987) Cerebral autoregulation and flow/metabolism coupling during cardiopulmonory bypass: The influence of PaCO2. Anesth analg. 66:665–672.

    Google Scholar 

  16. Kubota Y: (1968) Clinical study of the cerebral hemodynamics during extracorporeal circulation. Nagoya J Med Sci 13:117–142.

    Google Scholar 

  17. Wollman H, Stephen GW, Clement AJ, Danielson GK: (1966) Cerebral blood flow in man during extracorporeal circulation. J Thorac Cardiovasc Surg 52:558–564.

    PubMed  CAS  Google Scholar 

  18. Prough DS, Stump DA, Roy RC, Gravlee GP, Williams T, Mills SA, Hinshelwood L, Howard G: (1986) Response of cerebral blood flow to changes in carbon dioxide tension during hypothermic cardipulmonary bypass. Anesthesiology 64:576–581.

    Article  PubMed  CAS  Google Scholar 

  19. Lundar T, Lindegaard KF, Froysaker T, Aaslid R, Grip A, Nornes H: (1985) Dissociation between cerebral antoregulation and carbon dioxide reactivity during nonpulsatile cardiopulmonary bypass. Ann Thorac Surg 40:582–587.

    Article  PubMed  CAS  Google Scholar 

  20. Boysen G, Ladegaard-Pedersen HJ, Henriksen H, Olesen J, Paulson OB, Engell HC: (1971) The effects of PaCO2 on regional cerebral blood flow and internal carotid pressure during carotid clamping. Anesthesiology 35:286–300.

    Article  PubMed  CAS  Google Scholar 

  21. Harris EA, Seelye ER, Squire AW: (1971) Oxygen consumption during cardiopulmonary bypass with moderate hypothermia in man. Br J Anaesth 43:1113–1120.

    Article  PubMed  CAS  Google Scholar 

  22. Creech O, Bresler E, Halley M, Adam M: (1957) Cerebral blood flow during extracorporeal circulation. Surg Forum 8:510–520.

    PubMed  Google Scholar 

  23. Horecky J, Sujansky E, Cerven J, Pappova E: (1966) Some problems of extracorporeal circulation with respect to the cerebral circulation. J Cardiovasc Surg 7:79–83.

    CAS  Google Scholar 

  24. Anderson A, Waaben J, Husum B, Voldby B, Bodker A, Hansen AJ, Gjedde A: (1985) Nonpulsatile cardiopulmonary bypass disrupts the flow-metabolism couple in the brain. J Thorac Cardiovasc Surg 90:570–579.

    Google Scholar 

  25. Branthwaite MA: (1974) Cerebral blood flow and metabolism during open-heart surgery. Thorax 29:633–638.

    Article  PubMed  CAS  Google Scholar 

  26. Ream AK: (1982) Cardipulmonary bypass. In Acute Cardiovascular Management Anesthesia and Intensive Care, A. K. Ream and R.P. Fogdall (eds.). Toronto: J. B. Lippincott, pp. 420–455.

    Google Scholar 

  27. Gardner TJ, Horneffer PJ, Manolio TA, et al: (1985) Stroke following coronary artery bypass grafting: A ten-year study. Ann Thorac Surg 40:574–581.

    Article  PubMed  CAS  Google Scholar 

  28. Faro RS, Golden MD, Javid H, et al: (1983) Coronary revascularization in septuagenarians. J Thorac Cardiovasc Surg 86:616–620.

    PubMed  CAS  Google Scholar 

  29. Naritomi H, Meyer JS, Sakai F, Yamaguchi F, Shaw T: (1979) Effects of advancing age on regional cerebral blood flow. Arch Neurol 36:410–416.

    PubMed  CAS  Google Scholar 

  30. Lee WH, Brady MP, Rowe JM, Miller WC Jr: (1971) Effects of extracorporeal circulation upon behavior, personality, and brain function. Part II, Hemodynamic, metabolic and psychometric correlations. Ann Surg 173:1013–1022.

    Article  PubMed  Google Scholar 

  31. Lees MH, Herr RH, Hill JD, et al: (1970) Distribution of systemic blood flow of the rhesus monkey during cardiopulmonary bypass. J Thorac Cardiovasc Surg 61:570–586.

    Google Scholar 

  32. Held K: (1972) Die bedeutung des pulsierenden druckes fuer die autoregulation des hirnkreislaufs. Fortschr Med 90:777–778.

    PubMed  CAS  Google Scholar 

  33. Culliford AT, Colvin SB, Rohrer K, et al: (1986) The atherosclerotic ascending aorta and transverse arch: A new technique to prevent cerebral injury during bypass: experience with 13 patients. Ann Thorac Surg 41:27–35.

    Article  PubMed  CAS  Google Scholar 

  34. Hickey PR, Buckley MJ, Philbin DM: (1983) Pulsatile and nonpulsatile cardiopulmonary bypass: Review of a counterproductive controversy. Ann Thorac Surg 36:720–737.

    Article  PubMed  CAS  Google Scholar 

  35. Watkins WD, Peterson MB, Kong DL, et al: (1982) Thromboxane and prostacyclin changes during cardiopulmonary bypass with and without pulsatile flow. J Thorac Cardiovasc Surg 84:250–256.

    PubMed  CAS  Google Scholar 

  36. Sanderson JM, Wright G, Sims FW: (1972) Brain damage in dogs immediately following pulsatile and non-pulsatile blood flows in extracorporeal circulation. Thorax 27:275–86.

    Article  PubMed  CAS  Google Scholar 

  37. Jacobs LA, Klopp EH, Seamone W, Topaz SR, Gott, VL: (1969) Improved organ function during cardiac bypass with a roller pump modified to deliver pulsatile flow. J Thorac Cardiovasc Surg 58:703–712.

    PubMed  CAS  Google Scholar 

  38. Nussmeier NA, Arlund C, Slogoff S: (1986) Neuropsychiatric complications after cardiopulmonary bypass: cerebral protection by a barbiturate. Anesthesiology 64:165–170.

    Article  PubMed  CAS  Google Scholar 

  39. Woodcock TE, Murkin JM, Farrar JK, Tweed WA, Guiraudon GM, McKcnzie FN: (1987) Pharmacologic EEG suppression during cardiopulmonary bypass; cerebral hemodynamic and metabolic effects of thiopental or isoflurane during hypothermia and normothermia. Anesthesiology.

    Google Scholar 

  40. Hartmann A, Hoyer S (eds.): (1985) Cerebral Blood Flow and Metabolism Measurement. New York: Springer-Verlag, pp. 1–223.

    Google Scholar 

  41. Gelmers HJ (ed.): (1978) Regional Cerebral Blood Flow. Regulation Measurement and Changes with Diseases. The Netherlands: Van Gorcum & Comp.

    Google Scholar 

  42. Circulation and oxygen consumption in the brain. In Brain Energy Metabolism, BK Siesjo (ed.). New York: John Wiley & Sons, pp. 56–100.

    Google Scholar 

  43. Schenkin HA, Harmel MH, Kety SS: (1948) Dynamic anatomy of the cerebral circulation. Arch Neurol Psychiat 60:240–252.

    Google Scholar 

  44. Risberg J: (1980) Regional cerebral blood flow measurements by 133Xenon inhalation: Methodology and applications in neuropsychology and psychiatry. Brain and Language 9: 9–34.

    Article  PubMed  CAS  Google Scholar 

  45. Olesen J, Paulson OB, Lassen NA: (1971) Regional cerebral blood flow in man determined by the initial slope of the clearance of intra-arterially injected 133Xe. Stroke 2:519–540.

    Article  PubMed  CAS  Google Scholar 

  46. Obrist WD, Wilkinson WE: (1985) Stability and sensitivity of CBF indices of the noninvasive 133Xe method. In Cerebral Blood Flow and Metabolism Measurement, A. Hartman and S. Hoyer (eds.). New York: Springer-Verlag, pp. 30–36.

    Google Scholar 

  47. Chen RYZ, Fan FC, Kim S, Jan KM, Usani S, Chien S: (1980) Tissue-blood partition coefficient for xenon temperature and hematocrit dependence. J Appl Physiol 49:178–183.

    PubMed  CAS  Google Scholar 

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Authors
  1. John M. Murkin
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Editors and Affiliations

  1. University of Colorado, Denver, Colorado, USA

    Mark Hilberman

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© 1988 Martinus Nijhoff Publishing, Boston

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Murkin, J.M. (1988). Cerebral Hyperperfusion During Cardiopulmonary Bypass: The Influence of PaCO2 . In: Hilberman, M. (eds) Brain Injury and Protection During Heart Surgery. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-2075-3_4

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  • DOI: https://doi.org/10.1007/978-1-4613-2075-3_4

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4612-9231-9

  • Online ISBN: 978-1-4613-2075-3

  • eBook Packages: Springer Book Archive

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