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Macroembolization: Prevention and Outcome Modification

  • Chapter
Brain Injury and Protection During Heart Surgery

Abstract

Despite improvements in cardiac surgical techniques and extracorporeal apparatus, postoperative neurologic sequelae occasionally occur. Accumulating evidence points to macroembolization from the surgical field as the most common cause of cerebral dysfunction [1–13]. The risk of intraoperative macroembolism is greater in procedures requiring opening of a cardiac chamber (e.g., valve replacement or repair, ventricular aneurysm resection, or closure of a septal defect) than in coronary artery bypass grafting (CABG) [1,6,7,14,15]. Recent large series confirm a higher incidence of severe neurologic dysfunction after valve replacement (7.5%–24%) [1,2,5] compared to CABG (< 2%) [4,8,9]. Air embolism, for example, is more common after open chamber operations because large intracardiac bubbles can remain trapped after the heart is closed [6,16–19]. Macroembolism of particulate debris from the surgical field (e.g., calcium fragments [2,7], valve vegetations [13], intraventricular thrombus [8], or fat [10]) also is more common following open chamber surgery, and may be the cause of most permanent and/or severe dysfunction. Studies demonstrating that severe neurologic complications occur most frequently following replacement of extensively calcified valves support this view (figure 6–1) [2,5,7].

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References

  1. Slogoff S, Girgis KZ, Keats AS: (1982) Etiologic factors in neuropsychiatric complications associated with cardiopulmonary bypass. Anesth Analg 61:903–911.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  3. Aberg T, Ronquist G, Tyden H, Brunnkvist S, Hultman J, Bergstrom K, Lilja A: (1984) Adverse effects on the brain in cardiac operations as assessed by biochemical, psychometric, and radiologic methods. J Thorac Cardiovasc Surg 87:99–105.

    PubMed  CAS  Google Scholar 

  4. Martin WRW, Hashimoto SA: (1982) Stroke in coronary bypass surgery. Can J Neurol Sci 9: 21–26.

    PubMed  CAS  Google Scholar 

  5. Sotaniemi KA: (1980) Brain damage and neurological outcome after open-heart surgery. J Neurol Neurosurg Psychiatry 43:127–135.

    Article  PubMed  CAS  Google Scholar 

  6. Oka Y, Moriwaki KM, Hong Y, Chuculate C, Strom J, Andrews IC, Frater RWM: (1985) Detection of air emboli in the left heart by M-Mode transesophageal echocardiography following cardiopulmonary bypass. Anesthesiology 63:109–113.

    Article  PubMed  CAS  Google Scholar 

  7. Aberg T, Kihlgren M: (1977) Cerebral protection during open-heart surgery. Thorax 32:525–533.

    Article  PubMed  CAS  Google Scholar 

  8. Breuer AC, Furlan AJ, Hanson MR, Lederman RJ, Loop FD, Cosgrove DM, Greenstreet RL, Estafanous FG: (1983) Central nervous system complications of coronary artery bypass graft surgery: Prospective analysis of 421 patients. Stroke 14:682–687.

    Article  PubMed  CAS  Google Scholar 

  9. Gonzalez-Scarano F, Hurtig HI: (1981) Neurologic complications of coronary artery bypass grafting: Case-control study. Neurology 31:1032–1035.

    PubMed  CAS  Google Scholar 

  10. Ghatak NR, Sinnenberg RJ, DeBlois GG: (1983) Cerebral fat embolism following cardiac surgery. Stroke 14:619–621.

    Article  PubMed  CAS  Google Scholar 

  11. McKibbin DW, Bulkley BH, Green WR, Gott VL, Hutchins GM: (1976) Fatal cerebral atheromatous embolization after cardiopulmonary bypass. J Thorac Cardiovasc Surg 71: 741–745.

    PubMed  CAS  Google Scholar 

  12. Briely JB: (1967) Brain damage complicating open-heart surgery: A neuropathological study of 46 patients. Proc R Soc Med 60:858–859.

    Google Scholar 

  13. Gilman S: (1965) Cerebral disorders after open-heart operations. N Engl J Med 272:489–498.

    Article  PubMed  CAS  Google Scholar 

  14. Kolkka R, Hilberman M: (1980) Neurologic dysfunction following cardiac operation with low-flow, low-pressure cardiopulmonary bypass. J Thorac Cardiovasc Surg 79:432–437.

    PubMed  CAS  Google Scholar 

  15. Todd MM, Drummond JC: (1983) Cerebral protection during cardiac surgery. In Cardiac Anesthesia, J. A. Kaplan (ed.). New York: Grune and Stratton, pp. 551–577.

    Google Scholar 

  16. Taber RE, Maraan BM, Tomatis L: (1970) Prevention of air embolism during open-heart surgery: A study of the role of trapped air in the left ventricle. Surgery 68:685–691.

    PubMed  CAS  Google Scholar 

  17. Lawrence GH, McKay HA, Sherensky RT: (1971) Effective measures in the prevention of intraoperative aeroembolus. J Thorac Cardiovasc Surg 62:731–735.

    PubMed  CAS  Google Scholar 

  18. Rodigas PC, Meyer FI, Haasler GB, Dubroff JM, Spotnitz HM: (1982) Intraoperative 2-dimensional echocardiography: Ejection of microbubbles from the left ventricle after cardiac surgery. Am J Cardiol 50:1130–1132.

    Article  PubMed  CAS  Google Scholar 

  19. Nicks R: (1967) Arterial air embolism. Thorax 22:320–326.

    Article  PubMed  CAS  Google Scholar 

  20. Hughes D: (1981) Air embolism during cardiopulmonary bypass (letter). J Thorac Cardiovasc Surg 82:639.

    PubMed  CAS  Google Scholar 

  21. Taylor KM: (1982) Brain damage during open heart-surgery. Thorax 37:873–876.

    Article  PubMed  CAS  Google Scholar 

  22. Meldrum BS, Papy JJ, Vigouroux RA: (1971) Intracarotid air embolism in the baboon: Effects on cerebral blood flow and the electroencephalogram. Brain Res 25:301–315.

    Article  PubMed  CAS  Google Scholar 

  23. Price DL, Harris J: (1970) Cholesterol emboli in cerebral arteries as a complication of retrograde aortic perfusion during cardiac surgery. Neurology 20:1209–1214.

    PubMed  CAS  Google Scholar 

  24. Mills NL, Ochsner JL: (1980) Massive air embolism during cardiopulmonary bypass: Causes, prevention and management. J Thorac Cardiovasc Surg 80:708–717.

    PubMed  CAS  Google Scholar 

  25. Fritz H, Hossman KA: (1979) Arterial air embolism in the cat brain. Stroke 10:581–589.

    Article  PubMed  CAS  Google Scholar 

  26. Patterson RH Jr, Rosenfeld L, Porro RS: (1976) Transitory cerebral microvascular blockade after cardiopulmonary bypass. Thorax 31:736–741.

    Article  PubMed  Google Scholar 

  27. Garcia JH, Klatzo I, Archer T, Lossinsky AS: (1981) Arterial air embolism: Structural effects on the gerbil brain. Stroke 12:414–421.

    Article  PubMed  CAS  Google Scholar 

  28. Menkin M, Schwartzman RJ: (1977) Cerebral air embolism. Report of five cases and reviews of the literature. Arch Neurol 34:168–170.

    PubMed  CAS  Google Scholar 

  29. Spampinato N, Stassano P, Gagliardi C, Tufano R, Iorio D: (1981) Massive air embolism during cardiopulmonary bypass: Successful treatment with immediate hypothermia and circulatory support. Ann Thorac Surg 32:602–603.

    Article  PubMed  CAS  Google Scholar 

  30. Diethrich EB, Koopot R, Maze A, Dyess N: (1982) Successful reversal of brain damage from iatrogenic air embolism. Surg Gynecol Obstet 154:572–575.

    PubMed  CAS  Google Scholar 

  31. Ghosh PK, Kaplan O, Barak J, Lubliner J, Vidne BA: (1985) Massive arterial air embolism during cardiopulmonary bypass. J Cardiovasc Surg 26:248–250.

    CAS  Google Scholar 

  32. Gallagher EG, Pearson DT: (1973) Ultrasonic identification of sources of gaseous microemboli during open heart surgery. Thorax 28:295–305.

    Article  PubMed  CAS  Google Scholar 

  33. Solis RT, Noon GP, Beall AC, DeBakey ME: (1974) Particulate microembolism during cardiac operation. Ann Thorac Surg 17:332–344.

    Article  PubMed  CAS  Google Scholar 

  34. Aris A, Solanes H, Camara ML, Junque C, Escartin A, Caralps JM: (1986) Arterial line filtration during cardiopulmonary bypass: Neurologic, neuropsychologic, and hematologic studies. J Thorac Cardiovasc Surg 91:525–533.

    Google Scholar 

  35. Aberg T, Kihlgren M: (1974) Effect of open heart surgery on intellectual function. Scand J Thorac Cardiovasc Surg [Suppl 15] 8:1–63.

    Google Scholar 

  36. Krebber HJ, Hanrath P, Janzen R, Ritoff M, Rodewald G: (1982) Gas emboli during open heart surgery. Thorac Cardiovasc Surg 30:401–404.

    Article  PubMed  CAS  Google Scholar 

  37. Oka Y, Inoue T, Hong Y, Sisto DA, Strom JA, Frater RWM: (1986) Retained intracardiac air. Transesophageal echocardiography for definition of incidence and monitoring removal by improved techniques. J Thorac Cardiovasc Surg 91:329–338.

    PubMed  CAS  Google Scholar 

  38. Spotnitz HM, Malm JR: (1982) Two-dimensional ultrasound and cardiac operations. J Thorac Cardiovasc Surg 83:43–51.

    PubMed  CAS  Google Scholar 

  39. Duff HJ, Buda AJ, Kramer R, Strauss HD, David TE, Berman ND: (1980) Detection of entrapped intracardiac air with intraoperative echocardiography. Am J Cardiol 46:255–260.

    Article  PubMed  CAS  Google Scholar 

  40. Gomes OM, Pereira SN, Castagna RC, Bittencourt D, Amaral RVG, Zerbini EJ: (1973) The importance of the different sites of air injection in the tolerance of arterial air embolism. J Thorac Cardiovasc Surg 65:563–568.

    PubMed  CAS  Google Scholar 

  41. Padula RT, Eisenstat TE, Bronstein MH, Camishion RC: (1971) Intracardiac air following cardiotomy: Location, causative factors, and a method for removal. J Thorac Cardiovasc Surg 62:736–742.

    PubMed  CAS  Google Scholar 

  42. Golding LAR: (1985) New cannulation technique for the severely calcified ascending aorta. J Thorac Cardiovas Surg 90:626–627.

    CAS  Google Scholar 

  43. Akins CW: (1984) Noncardioplegic myocardial preservation for coronary revascularization. J Thorac Cardiovasc Surg 88:174–181.

    PubMed  CAS  Google Scholar 

  44. Cooley DA, Ott DA, Frazier OH, Walker WE: (1981) Surgical treatment of aneurysms of the transverse aortic arch: Experience with 25 patients using hypothermic techniques. Ann Thorac Surg 32:260–272.

    Article  PubMed  CAS  Google Scholar 

  45. Crawford ES, Stowe CL, Crawford JL, Titus JL, Weilbaecher DG: (1984) Aortic arch aneurysm: A sentinel of extensive aortic disease requiring subtotal and total aortic replacement. Ann Surg 199:742–752.

    Article  PubMed  CAS  Google Scholar 

  46. Stoney WS, Alford WC Jr, Burrus GR, Glassford DM Jr, Thomas CS Jr: (1980) Air embolism and other accidents using pump oxygenators. Ann Thorac Surg 29:336–340.

    Article  PubMed  CAS  Google Scholar 

  47. Kurusz M, Shaffer CW, Christman EW, Tyers GFO: (1979) Runaway pump head: New cause of gas embolism during cardiopulmonary bypass. J Thorac Cardiovasc Surg 77:792–795.

    PubMed  CAS  Google Scholar 

  48. Toscano M, Chiavarelli R, Ruvolo G, Macchiarelli A, Scibilia G, Marino B: (1983) Management of massive air embolism during open-heart surgery with retrograde perfusion of the cerebral vessels and hyperbaric oxygenation. Thorac Cardiovasc Surg 31:183–184.

    Article  PubMed  CAS  Google Scholar 

  49. Tomatis L, Nemiroff M, Riahi M, et al: (1981) Massive arterial air embolism due to rupture of pulsatile assist device. Successful treatment in the hyperbaric chamber. Ann Thorac Surg 32:604–608.

    Article  PubMed  CAS  Google Scholar 

  50. Steward D, Williams WG, Freedom R: (1977) Hypothermia in conjunction with hyperbaric oxygenation in the treatment of massive air embolism during cardiopulmonary bypass. Ann Thorac Surg 24:591–593.

    Article  PubMed  CAS  Google Scholar 

  51. Hendriks FFA, Bogers AJJC, de la Riviere AB, Huysmans HA, Brom GA: (1983) The effectiveness of venoarterial perfusion in treatment of arterial air embolism during cardiopulmonary bypass. Ann Thorac Surg 36:433–436.

    Article  PubMed  CAS  Google Scholar 

  52. Furlow TW Jr: (1982) Experimental air embolism of the brain: An analysis of the technique in the rat. Stroke 13:847–852.

    Article  PubMed  Google Scholar 

  53. Witoszka MM, Tamura H, Indeglia R, Hopkins RW, Simeone FA: (1973) Electroencephalographic changes and cerebral complications in open-heart surgery. J Thorac Cardiovasc Surg 66:855–864.

    PubMed  CAS  Google Scholar 

  54. Stockard J, Calanchini P, Bickford R, Billinger T: (1974) Electroencephalographic seizures during cardiopulmonary bypass. J Neurol Neurosurg Psychiatry 37:181–190.

    Article  PubMed  CAS  Google Scholar 

  55. Rampil IJ, Holzer JA, Quest DO, Rosenbaum SH, Correll JW: (1983) Prognostic value of computerized EEG analysis during carotid endarterectomy. Anesth Analg 62:186–192.

    Article  PubMed  CAS  Google Scholar 

  56. Michenfelder JD, Theye RA: (1968) Hypothermia: Effect on canine brain and whole-body metabolism. Anesthesiology 29:1107–1112.

    Article  PubMed  CAS  Google Scholar 

  57. Michenfelder JD: (1983) Brain hypoxia: Current status of experimental and clinical therapy. Seminars in Anesthesia 11:81–90.

    Google Scholar 

  58. Michenfelder JD, Theye RA: (1973) Cerebral protection by thiopental during hypoxia. Anesthesiology 39:510–517.

    Article  PubMed  CAS  Google Scholar 

  59. Michenfelder JD, Milde JH: (1975) Influence of anesthetics on metabolic, functional and pathological responses to regional cerebral ischemia. Stroke 6:405–410.

    Article  PubMed  CAS  Google Scholar 

  60. Smith AL, Hoff JT, Nielsen SL, Larson CP: (1974) Barbiturate protection in acute focal cerebral ischemia. Stroke 5:1–7.

    Article  PubMed  CAS  Google Scholar 

  61. Michenfelder JD, Milde JH, Sundt TM Jr: (1976) Cerebral protection by barbiturate anesthesia. Use after middle cerebral artery occlusion in Java monkeys. Arch Neurol 33:345–350.

    PubMed  CAS  Google Scholar 

  62. Corkill G, Sivalingam S, Reitan JA, Gilroy BA, Helphrey MG: (1978) Dose dependency of the post-insult protective effect of pentobarbital in the canine experimental stroke model. Stroke 9:10–12.

    Article  PubMed  CAS  Google Scholar 

  63. Moseley JI, Laurent JD, Molinari GF: (1975) Barbiturate attenuation of the clinical course and pathologic lesions in a primate stroke model. Neurology 25:870–874.

    PubMed  CAS  Google Scholar 

  64. Corkill G, Chikovani OK, McLeish I, McDonald LW, Youmans JR: (1976) Timing of pentobarbital administration for brain protection in experimental stroke. Surg Neurol 5:147–149.

    PubMed  CAS  Google Scholar 

  65. Selman WR, Spetzler RF, Roski RA, Roessmann U, Crumrine R, Macko R: (1982) Barbiturate coma in focal cerebral ischemia. Relationship of protection to timing of therapy. J Neurosurg 56:685–690.

    Article  PubMed  CAS  Google Scholar 

  66. Hoff JT, Smith AL, Hankinson HL, Nielsen SL: (1975) Barbiturate protection from cerebral infarction in primates. Stroke 6:28–33.

    Article  PubMed  CAS  Google Scholar 

  67. Michenfelder JD: (1974) The interdependency of cerebral functional and metabolic effects following massive doses of thiopental in the dog. Anesthesiology 41:231–236.

    Article  PubMed  CAS  Google Scholar 

  68. Kassell NF, Hitchon PW, Gerk MK, Sokoll MD, Hill TR: (1980) Alterations in cerebral blood flow, oxygen metabolism, and electrical activity produced by high dose sodium thiopental. Neurosurgery 7:598–603.

    Article  PubMed  CAS  Google Scholar 

  69. Becker KE Jr, Tonnesen AS: (1978) Cardiovascular effects of plasma levels of thiopental necessary for anesthesia. Anesthesiology 49:197–200.

    Article  PubMed  Google Scholar 

  70. Seltzer JL, Gerson JI, Allen FB: (1980) Comparison of the cardiovascular effects of bolus vs. incremental administration of thiopentone. Br J Anaesth 52:527–530.

    Article  PubMed  CAS  Google Scholar 

  71. Todd MM, Drummond JC, U HS: (1985) The hemodynamic consequences of high-dose thiopental anesthesia. Anesth Analg 64:681–687.

    Article  PubMed  CAS  Google Scholar 

  72. Reiz S, Balfors E, Friedman A, Haggmark S, Peter T: (1981) Effects of thiopentone on cardiac performance, coronary hemodynamics and myocardial oxygen consumption in chronic ischemic heart disease. Acta Anesthesiol Scand 25:103–110.

    Article  CAS  Google Scholar 

  73. Lyons SM, Clarke RSJ: (1972) A comparison of different drugs for anaesthesia in cardiac surgical patients. Br J Anaesth 44:575–583.

    Article  PubMed  CAS  Google Scholar 

  74. Stanski DR, Mihm FG, Rosenthal MH, Kalman SM: (1980) Pharmacokinetics of high-dose thiopental used in cerebral resuscitation. Anesthesiology 53:169–171.

    Article  PubMed  CAS  Google Scholar 

  75. Michenfelder JD: (1986) A valid demonstration of barbiturate-induced brain protection in man-at last (editorial views). Anesthesiology 64:140–142.

    Article  PubMed  CAS  Google Scholar 

  76. Yatsu FM: (1986) Barbiturate therapy for the ischemic brain (letter). New Engl J Med 315:397–398.

    Article  Google Scholar 

  77. Steen PA, Milde JH, Michenfelder JD: (1979) No barbiturate protection in a dog model of complete cerebral ischemia. Ann Neurol 5:343–349.

    Article  PubMed  CAS  Google Scholar 

  78. Snyder BD, Ramirez-Lassepas M, Sukhum P, Fryd D, Sung JH: (1979) Failure of thiopental of modify global anoxic injury. Stroke 10:135–141.

    Article  PubMed  CAS  Google Scholar 

  79. Todd MM, Chadwick HS, Shapiro HM, Dunlop BJ, Marshall LF, Dueck R: (1982) The neurologic effects of thiopental therapy following experimental cardiac arrest in cats. Anesthesiology 57:76–86.

    Article  PubMed  CAS  Google Scholar 

  80. Gisvold SE, Safar P, Hendricks HHL, Rao G, Moossy J, Alexander H: (1984) Thiopental treatment after global brain ischemia in pigtailed monkeys. Anesthesiology 60:88–96.

    Article  PubMed  CAS  Google Scholar 

  81. Brain resuscitation clinical trial I study group: (1986) Randomized clinical study of thiopental loading in comatose survivors of cardiac arrest. New Engl J Med 314:397–403.

    Article  Google Scholar 

  82. Yatsu FM: (1986) Cardiopulmonary-cerebral resuscitation (editorial). New Eng J Med 314:440–441.

    Article  PubMed  CAS  Google Scholar 

  83. Gisvold SE, Steen PA: (1985) Drug therapy in brain ischaemia. Br J Anaesth 57:96–109.

    Article  PubMed  CAS  Google Scholar 

  84. Ward JD, Becker DP, Miller JD, et al: (1985) Failure of prophylactic barbiturate coma in the treatment of severe head injury. J Neurosurg 62:383–388.

    Article  PubMed  CAS  Google Scholar 

  85. Bohn DJ, Biggar WD, Smith CR, Conn AW, Barker GA: (1986) Influence of hypothermia, barbiturate therapy and intracranial pressure monitoring on morbidity and mortality after near-drowing. Crit Care Med 14:529–534.

    Article  PubMed  CAS  Google Scholar 

  86. Newberg LA, Milde JH, Michenfelder JD: (1983) The cerebral metabolic effects of isoflurane at and above concentrations that suppress cortical electrical activity. Anesthesiology 59: 23–28.

    Article  PubMed  CAS  Google Scholar 

  87. Newberg LA, Michenfelder JD: (1983) Cerebral protection by isoflurane during hypoxemia or ischemia. Anesthesiology 59:29–35.

    Article  PubMed  CAS  Google Scholar 

  88. Casement B, Messick J, Milde L, Sharbrough F, Michenfelder J, Sundt T: (1985) “Critical” rCBF during isoflurane anesthesia in man. Anesthesiology 63:A406.

    Article  Google Scholar 

  89. Sharbrough FW, Messick JM, Jr, Sundt TM Jr: (1973) Correlation of continuous electroencephalograms with cerebral blood flow measurements during carotid endarterectomy. Stroke 4:674–683.

    Article  PubMed  CAS  Google Scholar 

  90. Todd MM, Hehls DG, Drummond JC, Spetzler RF, Thompson R, Johnson P: (1985) A comparison of the protective effects of isoflurane and thiopental in a primate model of temporary focal cerebral ischemia. Anesthesiology 63:A412.

    Article  Google Scholar 

  91. Warner DS, Deshpande JK, Wieloch T: (1986) The effect of isoflurane on neuronal necrosis following near-complete forebrain ischemia in the rat. Anesthesiology 64:19–23.

    Article  PubMed  CAS  Google Scholar 

  92. Bendo AA, Kass IS, Cottrell JE: (1985) Comparison of the protective effect of thiopental and isoflurane against anoxic damage in the rat hippocampal slice. Anesthesiology 63:A411.

    Article  Google Scholar 

  93. Feustal PJ, Ingvar MC, Severinghaus JW: (1981) Cerebral oxygen availability and blood flow during middle cerebral artery occlusion: Effects of pentobarbital. Stroke 12:858–863.

    Article  Google Scholar 

  94. Branston NM, Hope DT, Symon L: (1979) Barbiturates in focal ischemia of primate cortex: Effects on blood flow distribution, evoked potential and extracellular potassium. Stroke 10:647–653.

    Article  PubMed  CAS  Google Scholar 

  95. Kofke WA, Nemoto EM, Hossman KA, Taylor F, Kessler PD, Stezoski SW: (1979) Brain blood flow and metabolism after global ischemia and post-insult thiopental therapy in monkeys. Stroke 10:554–560.

    Article  PubMed  CAS  Google Scholar 

  96. Todd MM, Drummond JC: (1984) A comparison of the cerebrovascular and metabolic effects of halothane and isoflurane in the cat. Anesthesiology 60:276–282.

    Article  PubMed  CAS  Google Scholar 

  97. Simeone FA, Frazer G, Lawner P: (1979) Ischemic brain edema: Comparative effects of barbituates and hypothermia. Stroke 10:8–12.

    Article  PubMed  CAS  Google Scholar 

  98. Lawner P, Laurent J, Simeone F, Fink E, Rubin E: (1979) Attenuation of ischemic brain edema by pentobarbital after carotid ligation in the gerbil. Stroke 10:644–647.

    Article  PubMed  CAS  Google Scholar 

  99. Flamm ES, Demopoulos HB, Seligman ML, Ransohoff J: (1977) Possible molecular mechanisms of barbiturate-mediated protection in regional cerebral ischemia. Acta Neurol Scand [Suppl 64] 56:150–151.

    Google Scholar 

  100. Smith DS, Rehncrona S, Siesjo BK: (1980) Inhibitory effects of different barbiturates on lipid peroxiation in brain tissue in vitro: Comparison with the effects of promethazine and chlorpromazine. Anesthesiology 53:186–194.

    Article  PubMed  CAS  Google Scholar 

  101. Steen PA, Michenfelder JD: (1978) Cerebral protection with barbiturates: Relation to anesthetic effect. Stroke 9:140–142.

    Article  PubMed  CAS  Google Scholar 

  102. Nemoto EM, Shiu GK, Nemmer JP, Bleyaert AL: (1983) Free fatty acid accumulation in the pathogenesis and therapy of ischemic-anoxic brain injury. Am J Emerg Med 1:175–179.

    Article  PubMed  CAS  Google Scholar 

  103. Renou AM, Vernhiet J, Macrez P, et al: (1978) Cerebral blood flow and metabolism during etomidate anaesthesia in man. Br J Anaesth 50:1047–1051.

    Article  PubMed  CAS  Google Scholar 

  104. Van Reempts J, Borgers M, Van Eyndhoven J, Hermans C: (1982) Protective effects of etomidate in hypoxic-ischemic brain damage in the rat. A morphologic assessment. Exp Neurol 76:181–195.

    Article  PubMed  Google Scholar 

  105. Nugent M, Artru AA, Michenfelder JD: (1982) Cerebral metabolic, vascular and protective effects of midazolam maleate: Comparison to diazepam. Anesthesiology 56:172–176.

    Article  PubMed  CAS  Google Scholar 

  106. Artru AA, Michenfelder, JD: (1980) Cerebral protective, metabolic, and vascular effects of phenytoin. Stroke 11:377–382.

    Article  PubMed  CAS  Google Scholar 

  107. Astrup J, Skovsted P, Gjerris F, Sorensen HR: (1981) Increase in extracellular potassium in the brain during circulatory arrest: Effects of hypothermia, lidocaine, and thiopental. Anesthesiology 55:256–262.

    Article  PubMed  CAS  Google Scholar 

  108. Astrup J, Sorensen PM, Sorensen HR: (1981) Inhibition of cerebral oxygen and glucose consumption in the dog by hypothermia, pentobarbital, and lidocaine. Anesthesiology 55:263–268.

    Article  PubMed  CAS  Google Scholar 

  109. White BC, Winegar CD, Wilson RF, Hoehner PJ, Trombley JH Jr: (1983) Possible role of calcium blockers in cerebral resuscitation: A review of the literature and synthesis for future studies. Crit Care Med 11:202–207.

    Article  PubMed  CAS  Google Scholar 

  110. Gelmers HJ: (1985) Calcium-channel blockers: Effects on cerebral blood flow and potential uses for acute stroke. Am J Cardiol 55:144B–148B.

    Article  PubMed  CAS  Google Scholar 

  111. Steen PA, Newberg LA, Milde JH, Michenfelder JD: (1983) Nimodipine improves cerebral blood flow and neurologic recovery after complete cerebral ischemia in the dog. J Cereb Blood Flow Metabol 3:38–43.

    Article  CAS  Google Scholar 

  112. Steen PA, Newberg LA, Milde JH, Michenfelder JD: (1984) Cerebral blood flow and neurologic outcome when nimodipine is given after complete cerebral ischemia in the dog. J Cereb Blood Flow Metabol 4:82–87.

    Article  CAS  Google Scholar 

  113. Steen PA, Gisvold SE, Milde JH, et al: (1985) Nimodipine improves outcome when given after complete cerebral ischemia in primates. Anesthesiology 62:406–414.

    Article  PubMed  CAS  Google Scholar 

  114. Deshpande JK, Wieloch T: (1986) Flunarizine, a calcium entry blocker, ameliorates ischemic brain damage in the rat. Anesthesiology 64:215–224.

    Article  PubMed  CAS  Google Scholar 

  115. Allen GS, Ahn HS, Preziosi TJ, et al: (1983) Cerebral arterial spasm—A controlled trial of nimodipine in patients with subarachnoid hemorrhage. N Engl J Med 308:619–624.

    Article  PubMed  CAS  Google Scholar 

  116. Gelmers HJ: (1984) The effects of nimodipine on the clinical course of patients with acute ischemic stroke. Acta Neurol Scand, 69:232–239.

    Article  PubMed  CAS  Google Scholar 

  117. Schanne FAX, Kane AB, Young EE, Farber JL: (1979) Calcium dependence of toxic cell death: A final common pathway. Science 206:700–702.

    Article  PubMed  CAS  Google Scholar 

  118. Siesjo BK: (1981) Cell damage in the brain: A speculative synthesis. J Cereb Blood Flow Metab 1:155–185.

    Article  PubMed  CAS  Google Scholar 

  119. Steen PA, Newberg L, Milde JH, Michenfelder JD: (1983) Hypothermia and barbiturates: Individual and combined effects on canine cerebral oxygen consumption. Anesthesiology 58:527–532.

    Article  PubMed  CAS  Google Scholar 

  120. Lafferty JJ, Keykhah MM, Shapiro HM, Van Horn K, Behar MG: (1978) Cerebral hypo-metabolism obtained with deep pentobarbital anesthesia and hypothermia (30°C). Anesthesiology 49:159–164.

    Article  PubMed  CAS  Google Scholar 

  121. Quasha AL, Tinker JH, Sharbrough FW: (1981) Hypothermia plus thiopental: Prolonged electroencephalographic suppression. Anesthesiology 55:636–640.

    Article  PubMed  CAS  Google Scholar 

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  1. Nancy A. Nussmeier
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  2. John P. McDermott
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  1. University of Colorado, Denver, Colorado, USA

    Mark Hilberman

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© 1988 Martinus Nijhoff Publishing, Boston

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Nussmeier, N.A., McDermott, J.P. (1988). Macroembolization: Prevention and Outcome Modification. In: Hilberman, M. (eds) Brain Injury and Protection During Heart Surgery. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-2075-3_6

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  • DOI: https://doi.org/10.1007/978-1-4613-2075-3_6

  • 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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