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Cerebral perfusion during major cardiac surgery in children

Pediatric Cardiology volume 8, pages 161–165 (1987)Cite this article

Summary

Six children undergoing major cardiac surgery had extensive cerebral monitoring during cardiopulmonary bypass (CPB). The monitoring included continuous recording of arterial blood pressure (BP), central venous pressure (CVP), cerebral electrical activity by a cerebral function monitor (CFM), and middle cerebral artery (MCA) flow velocity by the transcranial pulsed Doppler (TCD) technique.

Introduction of the precooled blood containing priming solution resulted in rapid fall in BP as well as MCA velocities in these children at the start of CPB. During steady-state CPB at 20°C, MCA flow velocities were reduced in five of six children, range 45%–105% of pre-bypass value. These flow velocity values were recorded at cerebral perfusion pressures (CPP=BP−CVP) in the range of 14–26 mmHg. This reduced cerebral perfusion during steady-state CPB appears to be more than sufficient to meet the cerebral metabolic demands at the particular temperature. The reduced cerebral perfusion is in contrast to the enhanced perfusion found in adults during moderately hypothermic (28°–30°C) low-flow, low-pressure CPB previously reported. It was presumably due to the reduced temperature, reduced perfusion pressure, and less hemodilution.

During periods of constant temperature, hematocrit, and partial pressure of carbon dioxide (PaCO 2), MCA flow velocities varied passively with changes in CPP, demonstrating that cerebral autoregulation was not operative. Transcranial Doppler appears to be a suitable tool for investigating CPB techniques optimal with respect to cerebral circulation.

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Affiliations

  1. Department of Surgery, Rikshospitalet, Oslo, Norway

    Tryggve Lundar, Harald Lindberg, Karl-Fredrik Lindegaard, Steinar Tjønneland, Renate Rian, Gunnar Bø & Helge Nornes

  2. Department of Neurosurgery, Rikshospitalet, 0027, Oslo 1, Norway

    Tryggve Lundar, Harald Lindberg, Karl-Fredrik Lindegaard, Steinar Tjønneland, Renate Rian, Gunnar Bø & Helge Nornes

  3. Department of Anesthesiology, Rikshospitalet, Oslo, Norway

    Tryggve Lundar, Harald Lindberg, Karl-Fredrik Lindegaard, Steinar Tjønneland, Renate Rian, Gunnar Bø & Helge Nornes

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  1. Tryggve Lundar
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  2. Harald Lindberg
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  7. Helge Nornes
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Lundar, T., Lindberg, H., Lindegaard, KF. et al. Cerebral perfusion during major cardiac surgery in children. Pediatr Cardiol 8, 161–165 (1987). https://doi.org/10.1007/BF02263446

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  • DOI: https://doi.org/10.1007/BF02263446

Key words

  • Cerebral perfusion
  • Cardiac surgery
  • Pediatric surgery