Abstract
The Ladd transducer was used to measure anterior fontanel pressure in 23 infants undergoing cardiopulmonary bypass and profound hypothermic circulatory arrest for surgical correction of congenital heart disease. Mean (± SD) minimum oesophageal and rectal temperatures of 11.3 ± 1.5°C and 18.1 ± 2.2°C respectively were achieved with a mean duration of arrest of 53.4 ± 13.9 minutes. During reperfusion cardiopulmonary bypass after circulatory arrest, mean anterior fontanel pressure (18.3 ± 6.4 mmHg) increased above baseline pre-bypass values (10.6 ±2.9 mmHg) (p < 0.005). Mean arterial blood pressure decreased significantly from pre-bypass values (57.0 ± 11.8 mmHg) during both cooling (38.8 ±8.4 mmHg) and rewarming cardiopulmonary bypass (45.8 ± 8.9 mmHg) (p < 0.005). These changes were associated with a significant decrease in cerebral perfusion pressure during cooling (27.3 ± 11.0 mmHg) and rewarming cardiopulmonary bypass (27.5 ± 10.6 mmHg). compared with baseline pre-bypass values (46.5 ± 12.3 mmHg) (p < 0.005). The data demonstrate significant but transient decreases in cerebral perfusion pressure during cooling and rewarming bypass.
Résumé
Le transducteur de Ladd a été utilisé pour mesurer la pression de la fontanelle antérieure chez 23 nourrissons sous circulation extra-corporelle et arrêt circulatoire en hypothermie profonde pour correction chirurgicale de maladie cardiaque congénitale. Des températures oesophagiennes et rectales minimales moyennes (± SD) de 11.3 ± 1.5° C et de 18.1 ± 2.2° C respectivement, ont été atteintes avec une durée moyenne ďarrêt de 53.4 ± 13.9 minutes. Pendant la circulation extra-corporelle de reperfusion, post-arrêt circulatoire, la pression moyenne de la fontanelle antérieure (18.3 ± 6.4 mmHg) s’est élevée au-dessus des valeurs de base pré-circulation extra-corporelle (10.6 ± 2.9mmHg) (p < 0.005). La pression artérielle moyenne a diminué de façon significative sous les valeurs pré-circulation extra-corporelle (57.0 ± 11.8 mmHg) durant le refroidissement (38.8 ± 8.4 mmHg) et le réchauffement (45.8 ± 8.9 mmHg) (p < 0.005). Ces changements étaient associés à une diminution significative de la pression de perfusion cérébrale au refroidissement (27.3 ± 11.0 mmHg) et au réchauffement (27.5 ± 10.6 mmHg) en comparaison aux valeurs de base obtenues (46.5 ± 12.3 mmHg) (p < 0.005). Les données démontrent des diminutions significatives, quoique transitoires, de la pression de perfusion cérébrale durant le refroidissement et le réchauffement sous circulation extra-corporelle.
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Stow, P.J., Burrows, F.A., McLeod, M.E. et al. The effects of cardiopulmonary bypass and profound hypothermic circulatory arrest on anterior fontanel pressure in infants. Can J Anaesth 34, 450–454 (1987). https://doi.org/10.1007/BF03014347
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DOI: https://doi.org/10.1007/BF03014347