CJA
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Shenkman, Z.
Right arrow Articles by Shir, Y.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Shenkman, Z.
Right arrow Articles by Shir, Y.

Canadian Journal of Anesthesia, Vol 44, 1096-1101, Copyright © 1997 by Canadian Anesthesiologists' Society

ARTICLES

Cerebral protection using retrograde cerebral perfusion during hypothermic circulatory arrest

Z Shenkman, A Elami, YG Weiss, L Glantz, E Milgalter, B Drenger, FA Burrows and Y Shir
Department of Anesthesiology & CCM, Hadassah University Hospital, Jerusalem, Israel.

BACKGROUND: Retrograde cerebral perfusion through the superior vena cava (SVC) has been proposed to protect the brain from ischaemic injury during profound hypothermic circulatory arrest (PHCA). Its contribution to cerebral protection is unclear. Furthermore, the addition of anaesthetic or vasodilating agents to the SVC perfusate to enhance brain protection, has never been described. METHODS: In three patients undergoing repair of the ascending aorta utilizing PHCA, the upper body was retrogradely perfused with cold (16 degrees C) blood through the SVC by the cardiopulmonary bypass pump. Electroencephalographic activity was monitored using a computerized electroencephalographic monitor (Cerebro Trac 2500, SRD). Perfusion pressure was measured at a port in the cannula connector. Etomidate or thiopentone was injected into the SVC perfusate to arrest reappearing electroencephalographic activity. Nitroglycerin or nitroprusside was injected into the perfusate to increase retrograde flow and maintain a constant perfusion pressure. RESULTS: During PHCA periods of up to 61 min, recurrent electroencephalographic activity was abolished by the retrograde administration of small boluses of etomidate (total 50 mg) or thiopentone (total 500 mg). Nitroprusside (100 micrograms) and nitroglycerin (2 micrograms.kg-1.min-1) increased retrograde flow from 220 to 550 and 660 ml.min-1, respectively, while maintaining perfusion pressure (25-26 mmHg). Recovery from anaesthesia and surgery was uneventful, with no adverse neurological sequelae. CONCLUSION: Injection of anaesthetic agents into the retrograde SVC perfusate during PHCA, can suppress reoccurring electroencephalographic activity and retrograde injection of vasodilators can facilitate an increase in perfusion. It is suggested that both may augment brain protection.


This article has been cited by other articles:


Home page
 J. Thorac. Cardiovasc. Surg.Home page
A. Elami
Cerebral protection with retrograde cerebral perfusion
J. Thorac. Cardiovasc. Surg., February 1, 2003; 125(2): 441 - 441.
[Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
R. Bonser, D. Harrington, and D. Pagano
Reply
J. Thorac. Cardiovasc. Surg., February 1, 2003; 125(2): 441 - 441.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
D. L. Reich, S. Uysal, M. A. Ergin, and R. B. Griepp
Retrograde cerebral perfusion as a method of neuroprotection during thoracic aortic surgery
Ann. Thorac. Surg., November 1, 2001; 72(5): 1774 - 1782.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 1997 by the Canadian Anesthesiologists' Society.