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Canadian Journal of Anaesthesia

, Volume 44, Issue 10, pp 1096–1101 | Cite as

Cerebral protection using retrograde cerebral perfusion during hypothermic circulatory arrest

  • Ze’ev Shenkman
  • Amir Elami
  • Yoram G. Weiss
  • Lucio Glantz
  • Eli Milgalter
  • Benjamin Drenger
  • Frederick A. Burrows
  • Yoram Shir
Preliminary Report
Accepted:

Abstract

Background

Retrograde cerebral perfusion through the superior vena cava (SVC) has been proposed to protect the brain from ischaemic injury during profound hypothemnic 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°C) blood through the SVC by the cardiopulmonary bypass pump. Electroencephalographic activity was monitored using a computenzed 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 penods 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 μg) and nitroglycerin (2 μg · 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 reoccumng electroencephalographic activity and retrograde injection of vasodilators can facilitate an increase in perfusion. It is suggested that both may augment brain protection.

Keywords

Thiopentone Superior Vena Cava Etomidate Circulatory Arrest Burst Suppression 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif

La perfusion cérébrale rétrograde par la veine cave supérieure (VCS) pourrait protéger le cerveau de l’ischémie pendant l’arrêt circulatoire en hypothermie profonde (ACHP) mais cette hypothèse n’est pas prouvée. En outre, on n’a jamais rapporté non plus que les agents anesthésiques ou vasodilatateurs ajoutés au liquide de perfusion de la VCS amplifiaient la protection cérébrale.

Méthodes

Au cours d’une réparation de l’aorte ascendante sous ACHP, on a perfusé la partie supérieure du corps de trois patients par voie rétrograde avec du sang froid (16C) par la VCS à l’aide d’une pompe de circulation extracorponelle. Un moniteur informatisé (Cenebro Trac 2500, SRD) a servi a monrtorer l’activité électroencéphalographique. La pression de perfusion était mesurée par un orifice situé sur la canule. L’activité électroencéphalographique était interrompue par l’injection dans le liquide de perfusion de la VCS d’étomidate et de thiopental. Le nitroprussiate et la nitroglycénne étaient ajoutés au perfusat afin d’augmenter le flux rétrograde et maintenir constante la pression de perfusion.

Résultats

L’admmistration rétrograde de petits bolus d’étomidate (total 50 mg) ou de thiopental (total 500 mg) a aboli la reprise de l’activité électroencéphalographique pendant 61 min d’ACPH ou moins. Le nitroprussiate (100 μg) et la nitroglycérine (2 μg · kg−1 · min−1) ont accru le flux rétrograde de 220 à 550 et à 660 ml · min−1 respectivement, tout en maintenant la pression de perfusion constante (25–26 mmHg). La récupération anesthésique et chirurgicale s’est deroulee sans problèmes ni séquelles neurologiques.

Conclusion

Linjection d’agents anesthésiques dans le liquide de perfusion rétrograde de la VCS pendant l’ACPH peut suppnmer la repnse de l’activité électroencéphalographique. L’injection rétrograde de vasodilatateurs peut favoriser l’augmentation de la perfusion. Ces deux interventions pourraient accroître la protection cérébrale.

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Copyright information

© Canadian Anesthesiologists 1997

Authors and Affiliations

  • Ze’ev Shenkman
    • 1
  • Amir Elami
    • 2
  • Yoram G. Weiss
    • 1
  • Lucio Glantz
    • 1
  • Eli Milgalter
    • 2
  • Benjamin Drenger
    • 1
  • Frederick A. Burrows
    • 3
  • Yoram Shir
    • 1
  1. 1.Department of Anesthesiology & CCMHadassah University Hospital and the Hebrew UniversityJerusalemIsrael
  2. 2.Department of Cardiothoracic SurgeryHadassah University Hospital and the Hebrew UniversityJerusalemIsrael
  3. 3.Department of AnesthesiaThe Children’s Hospital Medical Center and Harvard Medical SchoolBoston

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