Zusammenfassung
Zerebrale Ischämie als Komplikation von Eingriffen unter extrakorporalem Kreislauf kann sich als postoperative zerebrale Dysfunktion zeigen, vom sogenannten Durch-gangssyndrom bis zum tiefen Koma, mit Krampfanfällen oder Herdsymptomatik. Die Häufigkeitsangaben schwanken von 7% bis 44% unmittelbar nach dem Eingriff für vorübergehende und 1,6 bis 23% für bleibende neurologische Schäden (Slogoff et al. [17], Barash [3]). Es gibt sogar Hinweise, daß schlicht alle kardiochirurgischen Eingriffe mit zerebraler Beeinträchtigung verbunden sind (Aberg et al. [1]). Ursachen sind globale inkomplette Ischämie durch prolongierte Hypotension (Malone et al. [11]) oder fokale Ischämie durch Luft- und Partikelembolie (Brierly [6], Slogoff et al. [17]). Zerebrale Hyperaktivität in Krampfanfällen nach extrakorporalem Kreislauf kann mit fortschreitender Substratverarmung und Laktatansammlung, vor allem aber Kalziumanhäufung, zu Schadensmustern ähnlich dem nach globaler kompletter Ischämie führen (Meldrum et al. [12]).
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Literatur
Aberg T, Ronquist G, Tydén H, Ahlund P, Bergström K (1982) Release of adenylate kinase into cerebrospinal fluid during open heart surgery and its relation to postoperative intellectual function. Lancet 1:1139.
Abramson NS, Safar P, Detre K, Kelsey S, Monroe J, Reinmuth O, Snyder J, Mullie A, Hedstrand U, Tammisto T, Lund J, Breivik H, Lind B, Jastremski M (1983) Results of a randomized clinical trial of brain resuscitation with thiopental. Anesthesiology 59:A101.
Barash PG (1980) Cardiopulmonary bypass and postoperative neurologic dysfunction. Am Heart J 99:675.
Branston NM, Hope DT, Symon L (1979) Barbiturates in focal ischaemia of primate cortex. Effects on blood flow distribution, evoked potential and extracellular potassium. Stroke 10:647.
Branthwaite MA (1975) Prevention of neurological damage during open heart surgery. Thorax 30:258.
Brierly JB (1963) Neuropathological findings in patients dying after open-heart surgery. Thorax 18:291.
Carlson RG, Lande AJ, Landis A, Ragoz B, Baxter J, Patterson RH, Stenzel K, Lillehei CW (1973) The Lande-Edwards membrane oxygenator during heart surgery. J Thorac Cardiovasc Surg 66:894.
Ellis RJ, Wisniewski A, Potts R, Calhoun C, Loucks P, Wells MR (1980) Reduction of flow rate and arterial pressure at moderate hypothermia does not result in cerebral dysfunction. J Thorac Cardiovasc Surg 79:173.
Henriksen L, Hjelms E, Lindeburgh T (1983) Brain hyperperfusion during cardiac operations. Cerebral blood flow measured in man by intraarterial injection of xenon 133: Evidence suggestive of intraoperative microembolism. J Thorac Cardiovasc Surg 86:202.
Kolkka R, Hilberman M (1980) Neurologic dysfunction following cardiac operation with low flow pressure-cardiopulmonary bypass. J Thorac Cardiovasc Surg 79:432.
Malone M, Prior P, Scholtz C (1981) Brain damage after cardiopulmonary bypass: correlations between neurophysiological and neuropathological findings. J Neurol Neurosurg Psychiat 44:924.
Meldrum B, Evans M, Griffiths T, Simon R (1985) Ischaemic brain damage: The role of excitatory activity and of calcium entry. Br J Anaesth 57:44.
Muraoka R, Yokota M, Aoshima M, Kyoku J, Nomoto S et al (1981) Subclinical changes in brain morphology following cardiac operations as reflected by computed tomographic scans of the brain. J Thorac Cardiovasc Surg 81:364.
Nussmeier NA, Arlund C, Slogoff S (1986) Anesthesiology 64:165.
Orlowski JP, Erenberg G, Lueders H, Cruse R (1984) Hypothermia and barbiturate coma for refractory status epilepticus. Crit Care Med 12:367.
Selman WR, Roessman UR, Roesblatt HJ, Crumrine RC (1981) Barbiturate induced coma therapy for focal cerebral ischaemia. effect after temporary and permanent MCA occlusion. J Neurosurg 55:220.
Shapiro HM (1985) Barbiturates in brain ischaemia. Br J Anaesth 57:82.
Slogoff S, Girgis KZ, Keats AS (1982) Etiologic Factors in Neuropsychiatric Complications Associated with Cardiopulmonary Bypass. Anesth Analg 61:903.
Spetzler RF, Selman WR, Roski RA, Bonstelle C (1982) Cerebral revascularization during barbiturate coma in primates and humans. Surg Neurol 17:111.
Stockard JJ, Bickford RG, Schauble JF (1973) Pressure dependent cerebral ischemia during cardiopulmonary bypass. Neurology 23:521.
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
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Wiedemann, K., Jürs, G., Krier, C., Assmus, A. (1986). Hochdosierte Thiopentalinfusion bei zerebraler Dysfunktion nach extrakorporalem Kreislauf. In: List, W.F., Steinbereithner, K., Schalk, H.V. (eds) Intensiv- und Notfallmedizin — Neue Aspekte. Anaesthesiologie und Intensivmedizin Anaesthesiology and Intensive Care Medicine, vol 194. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-71284-5_17
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