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The Journal of Cardiovascular Surgery 2000 June;41(3):371-5

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

The effect of carbon dioxide tension on cerebral circulation during hypothermic selective cerebral perfusion

Takahara Y., Sudo Y., Nakano H., Sato T.

From the Division of Cardiovascular Surgery, Funabashi Municipal Medical Center, Funabashi, Japan


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Back­ground. ­Some ­reports ­have ­observed the ­response of cere­bral ­blood ­flow to ­PaCO2 ­during hypo­thermic car­di­o­pul­mo­nary ­bypass. We ­studied the ­effect of ­PaCO2 on the cere­bral cir­cu­la­tion ­during hypo­thermic selec­tive cere­bral per­fu­sion.
­Methods. ­Between ­June 1992 and Jan­uary 1998, 35 ­patients under­went ­aortic ­arch ­grafting ­using hypo­thermic selec­tive cere­bral per­fu­sion (20ºC). In the ear­lier ­four ­patient (­Group 1), ­carbon ­dioxide gas was not ­added. In the ­latter 31 ­patient (­Group 2), ­carbon ­dioxide gas was ­added to the cere­bral per­fu­sion. The hemo­dy­namics and ­rates of ­change in cere­bral ­oxygen sat­u­ra­tion ­were eval­u­ated.
­Results. In ­Group 1, the ­index of cere­bral arte­rial resis­tance was 9.2±2.2 at the ­start of selec­tive cere­bral per­fu­sion and ­increased to 15.7±0.1 at the re-­warming ­stage (p<0.05), and ­there was a sig­nif­i­cant ­decrease in cere­bral ­oxygen sat­u­ra­tion at the re-­warming ­stage (p<0.001). In ­Group 2, the ­index of cere­bral arte­rial resis­tance was 4.7±1.7 at the ­start of selec­tive cere­bral per­fu­sion and 4.3±1.5 at the re-­warming ­stage, a non-sig­nif­i­cant ­change. The ­change in cere­bral ­oxygen sat­u­ra­tion was ­also non-sig­nif­i­cant ­between the ­start of selec­tive cere­bral per­fu­sion and the re-­warming ­stage. ­Among the neu­ro­log­ical out­comes, ­there was ­only one ­small cere­bral infarc­tion in ­Group 2; how­ever, no ­delayed con­scious ­recovery was ­observed.
Con­clu­sions. The addi­tion of CO2 to cere­bral per­fu­sion was a ­factor in inhib­iting the ­increase in the cere­bral vas­cular resis­tance at the re-­warming ­stage.

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