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The purpose of this study was to evaluate the roles of different housing environments in neurological function,cerebral metabolism,cerebral infarction and neuron apoptosis after focal cerebral ischemia.Twenty-eight Sprague-Dawley rats were divided into control group (CG) and cerebral ischemia group,and the latter was further divided into subgroups of different housing conditions:standard environment (SE) subgroup,individual living environment (IE) subgroup,and enriched environment (EE) subgroup.Focal cerebral ischemia was induced by the middle cerebral artery occlusion (MCAO).Beam walking test was used to quantify the changes of overall motor function.Cerebral infarction and cerebral metabolism were studied by in vivo magnetic resonance imaging and 1H-magnetic resonance spectra,respectively.Neuron necrosis and apoptosis were detected by hematoxylin-eosin and TUNEL staining methods,respectively.The results showed that performance on the beam-walk test was improved in EE subgroup when compared to SE subgroup and IE subgroup.Cerebral infarct volume in IE subgroup was significantly larger than that in SE subgroup (P＜0.05) and EE subgroup (P＜0.05) on day 14 after MCAO.NAA/Cr and Cho/Cr ratios were lower in MCAO groups under different housing conditions as compared to those in CG (P＜0.05).NAA/Cr ratio was lower in IE subgroup (P＜0.05) and higher in EE subgroup (P＜0.05) than that in SE subgroup.NAA/Cr ratio in EE was significantly higher than that in IE subgroup (P＜0.05).Cho/Cr ratio was decreased in MCAO groups as compared to that in CG (P＜0.05).A significant decrease in normal neurons in cerebral cortex was observed in MCAO groups as compared to CG (P＜0.05).The amount of normal neurons was less in IE subgroup (P＜0.05),and more in EE subgroup (P＜0.05) than that in SE subgroup after MCAO.The amount of normal neurons in EE subgroup was significantly more than that in IE subgroup after MCAO (P＜0.05).The ratio of TUNEL-positive neurons in EE was significantly lower than that in SE subgroup (P＜0.05) and IE subgroup (P＜0.05).Correlation analysis showed that the beam walking test was negatively correlated with NAA/Cr ratio (P＜0.05).Cerebral infarct volume was negatively correlated with both NAA/Cr ratio (P＜0.01) and Cho/Cr ratio (P＜0.01).The amount of normal cortical neurons was positively correlated with both NAA/Cr ratio (P＜0.01) and Cho/Cr ratio (P＜0.05).The TUNEL-positive neurons showed a negative correlation with both NAA/Cr ratio (P＜0.01) and Cho/Cr ratio (P＜0.01).This study goes further to show that EE may improve neurological functional deficit and cerebral metabolism,decrease cerebral infarct volume,neuron necrosis and apoptosis,while IE may aggravate brain damage after MCAO.
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The purpose of this study was to evaluate the roles of different housing environments in neurological function,cerebral metabolism,cerebral infarction and neuron apoptosis after focal cerebral ischemia.Twenty-eight Sprague-Dawley rats were divided into control group (CG) and cerebral ischemia group,and the latter was further divided into subgroups of different housing conditions:standard environment (SE) subgroup,individual living environment (IE) subgroup,and enriched environment (EE) subgroup.Focal cerebral ischemia was induced by the middle cerebral artery occlusion (MCAO).Beam walking test was used to quantify the changes of overall motor function.Cerebral infarction and cerebral metabolism were studied by in vivo magnetic resonance imaging and 1H-magnetic resonance spectra,respectively.Neuron necrosis and apoptosis were detected by hematoxylin-eosin and TUNEL staining methods,respectively.The results showed that performance on the beam-walk test was improved in EE subgroup when compared to SE subgroup and IE subgroup.Cerebral infarct volume in IE subgroup was significantly larger than that in SE subgroup (P＜0.05) and EE subgroup (P＜0.05) on day 14 after MCAO.NAA/Cr and Cho/Cr ratios were lower in MCAO groups under different housing conditions as compared to those in CG (P＜0.05).NAA/Cr ratio was lower in IE subgroup (P＜0.05) and higher in EE subgroup (P＜0.05) than that in SE subgroup.NAA/Cr ratio in EE was significantly higher than that in IE subgroup (P＜0.05).Cho/Cr ratio was decreased in MCAO groups as compared to that in CG (P＜0.05).A significant decrease in normal neurons in cerebral cortex was observed in MCAO groups as compared to CG (P＜0.05).The amount of normal neurons was less in IE subgroup (P＜0.05),and more in EE subgroup (P＜0.05) than that in SE subgroup after MCAO.The amount of normal neurons in EE subgroup was significantly more than that in IE subgroup after MCAO (P＜0.05).The ratio of TUNEL-positive neurons in EE was significantly lower than that in SE subgroup (P＜0.05) and IE subgroup (P＜0.05).Correlation analysis showed that the beam walking test was negatively correlated with NAA/Cr ratio (P＜0.05).Cerebral infarct volume was negatively correlated with both NAA/Cr ratio (P＜0.01) and Cho/Cr ratio (P＜0.01).The amount of normal cortical neurons was positively correlated with both NAA/Cr ratio (P＜0.01) and Cho/Cr ratio (P＜0.05).The TUNEL-positive neurons showed a negative correlation with both NAA/Cr ratio (P＜0.01) and Cho/Cr ratio (P＜0.01).This study goes further to show that EE may improve neurological functional deficit and cerebral metabolism,decrease cerebral infarct volume,neuron necrosis and apoptosis,while IE may aggravate brain damage after MCAO.
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Objective@#To study the clinical effect of high pressure oxygen and Butylphthalide in the recovery of cerebral metabolism after carbon monoxide poisoning.@*Methods@#84 patients treated from May 2014 to May 2016 in our hospital were selected. The subjects were randomly and equally divided into two groups. The control group adopted the conventional therapy and high pressure oxygen; on the basis, the observation group also took Butylphthalide. The clinical effect, duration of coma, recovery of consciousness, incidence rate of delayed encephalopathy was observed. After 1m of treatment, the HDS point was evaluated.@*Results@#The total effective rate of control group (76.19%, 32/42) was lower than that of observation group (95.24%, 40/42) (P<0.05) . The duration of coma for observation group was shorter than that of control group. The percentage for patients with recovery of consciousness and incidence rate of delayed encephalopathy for observation group was better than that of control group (P<0.05) . The HDS point for observation group was even higher than that of control group (P<0.05) .@*Conclusion@#The high pressure oxygen and butylphthalide can improve the clinical effective rate, shorten the duration of coma and promote the patient’s recovery of consciousness. It is worthy of clinical promotion.
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Pediatric intensive care unit(PICU) is the last guarantee for children whose lives were threatened.Brain injury are accompanied in many patients,in which ones dying or surviving were associated with whether their cerebral function would be recovered.Closely monitoring the brain function,especially the metabolic balance of cerebral oxygenation to detect cerebral hypoperfusion and low oxygen delivery and timely interventions being introduced can reduce mortality and longterm sequela.Current trends in monitoring cerebral oxygenation are poor in PICUs of our country.It is very helpful in evaluating cerebral function and predicting prognosis from learning characteristics of cerebral oxygenic balance and monitoring methods of cerebral oxygenation.At present,monitoring cerebral oxygen includes intracranial pressure,cerebral perfusion pressure,jugular venous oxygen saturation,brain tissue oxygen tension,cerebral blood flow,and near infrared spectrum technology and so on.
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<p><b>OBJECTIVE</b>To investigate the effects of Shenfu Injection (, SFI) on cerebral metabolism in a porcine model of cardiac arrest (CA).</p><p><b>METHODS</b>Thirty Wuzhishan minipigs were randomly assigned to the control group (n=6), epinephrine group (EP group, n=12) and Sfigroup (n=12). After 8 min of untreated ventricular fifibrillation (VF), pigs in the EP group or Sfigroup were administered with either EP (0.02 mg/kg) or Sfi(1.0 mL/kg), respectively. After successful resuscitation, cerebrospinal fluid (CSF) levels of glucose, pyruvate, lactate, glutamate and glycerol were measured at 1, 6, 12 and 24 h after recover from spontaneous circulation (ROSC). In addition, neurologic defificit score (NDS) was calculated at 24 h after ROSC. Surviving pigs were killed at 24 h after ROSC, and the brain tissue was obtained for ultra-microstructure examination.</p><p><b>RESULTS</b>Compared with the EP group, CSF glucose and pyruvate levels were higher (all P<0.01), and lactate levels were lower in the Sfigroup (P<0.01). Meanwhile, CSF glutamate and glycerol levels in the Sfigroup were lower in comparison to the EP group (all P<0.05). In addition, Sfidecreased NDS at 24 h after ROSC (P<0.01), and alleviated the histopathological damage of the brain.</p><p><b>CONCLUSIONS</b>Sficould alleviate brain injury after CA, which may be associated with improving cerebral metabolism.</p>
Subject(s)
Animals , Blood Circulation , Blood Gas Analysis , Brain , Metabolism , Cardiopulmonary Resuscitation , Disease Models, Animal , Drugs, Chinese Herbal , Pharmacology , Therapeutic Uses , Heart Arrest , Cerebrospinal Fluid , Drug Therapy , Injections , Jugular Veins , Metabolism , Perfusion , Sus scrofaABSTRACT
Objective To investigate the variation of multivoxel 1 H magnetic resonance spectroscopy(1 H-MRS)before and after continuous positive airway pressure(CPAP)treatment in obstructive sleep apnea hypopnea syndrome(OSAHS).Methods Brain multivoxel 1 H-MRS examinations were performed in 25 cases of moderate or severe OSAHS patients before and after CPAP treat-ment,and 25 cases of healthy.The ratios of brain metabolites of the frontal lobe were recorded and analyzed respectively.To observe whether the lactate(Lac)peak appeared or not.Results In the frontal lobe,the NAA/Cr,NAA/Cho of the patients before treatment (2.021 2±0.231 2 and 1.608 8±0.257 1,respectively)was decreased compared with the healthy (2.726 8±0.607 1 and 2.445 6± 0.437 5).The NAA/Cr,NAA/Cho of the patients after treatment (2.314 0±0.312 8 and 2.01 6 4±0.424 0,respectively)was in-creased compared with the patients before treatment (2.021 2±0.231 2 and 1.608 8±0.257 1).The NAA/Cr,NAA/Cho of the pa-tients after treatment (2.314 0±0.312 8 and 2.01 6 4±0.424 0,respectively)was decreased compared with the healthy (2.726 8± 0.607 1 and 2.445 6±0.437 5),and the difierences were statistically significant (P <0.01).The Cho/Cr of the patients before treatment (1.293 2±0.261 5)was increased compared with the healthy (1.129 2±0.157 7),the difference was statistically significant(P <0.05).Lac peak was not detected in all.Conclusion Multivoxel 1 H-MRS can demonstrate sensitively the changes of brain metabolism in pa-tients with OSAHS before and after CPAP treatment,and may provide imaging evidence for clinical therapeutic effect and prognostic evaluation.
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Objective To compare the effect on intraoperative cerebral metabolism between the propofol combined with remifentanil infusion in total intravenous anesthesia and the desflurane combined with remifentanil intravenous inhalation anesthesia in patients in neurosurgery.Methods Thirty-four patients were randomly divided into the propofol combined with remifentanil group (group A,n=16) and the desflurane combined with remifentanil group (group B,n =18).The B-ultrasound under the guide of retrograde catheterization through right internal jugular vein and artery was prepared after the patients entered the operation room.Atropine,propofol,fentanyl,rocuronium were used in the induction of anesthesia.The mechanical ventilation was applied after conventional trachea cannula.Once patients were anesthetized steadily,jugular bulb venous oxygen saturation (SjvO2),jugular bulb venous oxygen partial pressure (PjvO2),Jugular Bulb venous hemoglogin (Hbv),jugular bulb venous lactate (Ljv),jugular bulb venous gluxose (Gv),arterial oxygen saturation (SaO2),arterial oxygen pressure (PaO2),arterin (Hba),arterial blood lactate (La),arterial blood gluxose (Ga),arterial blood oxygen content (CaO2),jugular bulb venous oxygen content (CjvO2),arteriovenous oxygen difference (AVDO2),cerebral extraction of oxygen (CEO2),cerebral lactate production rate (CLP) and cerebral glucose uptake rate (CGU) at different time [before anesthesia induction (T1),1 hours after the start of the operation (T2),2 hours after the start of the operation (T3),half an hour after the operation]were collected.Results (1) The value of SjvO2,PjvO2,CjvO2 and CaO2 in group B was significantly higher than that in group A (P＜0.001);The value of AVDO2 and CEO2 in group B was lower than that in group A (P＜0.05);(2) The value of Gv and Ga in group B was higher than that in group A (P＜0.05);There were no significant differences about CGU in two groups (P＞0.05);(3) The value of CLP in group B was lower than that in group A (P＜0.05);there were no significant differences about Ljv and La in two groups (P＞0.05);(4) Compared with the value at moment of T1 between group A and group B,the value ofPaO2,SaO2,PjvO2 and SjvO2 were increased with time (P＜0.05),the value of CaO2,CjvO2,AVDO2 and CEO2 showed a downward trend (P ＜0.05).Conclusion (1) Both total intravenous anesthesia and intravenous inhalation anesthesia can reduce the cerebral oxygen metabolism;(2) For the cerebral protection of neurosurgery operation,it seems that the effect of intravenous inhalation anesthesia is more stronger than total intravenous anesthesia.
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Objective To study the effect of electroencephalograph (EEG) bionic electrical stimulation at Wangu (GB12), Tianzhu (BL10), Neiguan (PC6) on cerebral blood flow and metabolism in patients with persistent vegetative state (PVS). Methods 60 patients with PVS were divided into observation group (n=30) and control group (n=30) according to the random number table. The control group re-ceived routine treatment, including basic management, hyperbaric oxygen therapy, awaking medicine, sensory stimulation, and so on;while the observation group received EEG bionic electrical stimulation at bilateral Tianzhu, Wangu (cheif electrodes) and Neiguan (auxiliary elec-trodes) in addition. They were treated for 30 days. They were assessed with the PVS score, and observed with transcranial Doppler ultra-sound (TCD) and magnetic resonance spectroscopy (MRS) one day before and one day after treatment. Results The incidence of improve-ment was 86.67%in the observation group, more than 60.00%in the control group (P<0.05). The difference of blood flow velocity before and after treatment (ΔVm) of anterior-middle cerebral artery was more in the observation group than in the control group respectively (P<0.001), as well as those of posterior cerebral-vertebral-basilar artery (P<0.01). The N-acetyl aspartic acid/creatine (NAA/Cr) increased more in the observation group than in the control group respectively (P<0.01), and the choline/creatine (Cho/Cr) decreased more (P<0.01), after treatment. Conclusion EEG bionic electrical stimulation can improve the cerebral circulation and metabolism in patients with PVS, which may associate with the wake promoting.
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@#Objective To study the effect of electroencephalograph (EEG) bionic electrical stimulation at Wangu (GB12), Tianzhu (BL10), Neiguan (PC6) on cerebral blood flow and metabolism in patients with persistent vegetative state (PVS). Methods 60 patients with PVS were divided into observation group (n=30) and control group (n=30) according to the random number table. The control group received routine treatment, including basic management, hyperbaric oxygen therapy, awaking medicine, sensory stimulation, and so on; while the observation group received EEG bionic electrical stimulation at bilateral Tianzhu, Wangu (cheif electrodes) and Neiguan (auxiliary electrodes) in addition. They were treated for 30 days. They were assessed with the PVS score, and observed with transcranial Doppler ultrasound (TCD) and magnetic resonance spectroscopy (MRS) one day before and one day after treatment. Results The incidence of improvement was 86.67% in the observation group, more than 60.00% in the control group (P<0.05). The difference of blood flow velocity before and after treatment (ΔVm) of anterior-middle cerebral artery was more in the observation group than in the control group respectively (P< 0.001), as well as those of posterior cerebral-vertebral-basilar artery (P<0.01). The N-acetyl aspartic acid/creatine (NAA/Cr) increased more in the observation group than in the control group respectively (P<0.01), and the choline/creatine (Cho/Cr) decreased more (P<0.01), after treatment. Conclusion EEG bionic electrical stimulation can improve the cerebral circulation and metabolism in patients with PVS, which may associate with the wake promoting.
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Introducción: El incremento del consumo de oxígeno y del flujo sanguíneo cerebral, así como de la presión intracraneal son los efectos adversos, que limitan el uso de la ketamina en anestesia neuroquirúrgica; sin embargo, actualmente se reexamina su uso, al tener como fundamento su efecto neuroprotector. Material y método: Se estudiaron 40 pacientes intervenidos quirúrgicamente por craniotomía con diagnóstico de tumores supratentoriales, los cuales recibieron una anestesia total intravenosa, en la que se empleó alternativamente fentanil o ketamina para asegurar la analgesia en cada grupo. Se registró la presión arterial de dióxido de carbono (PaCO2), saturación venosa yugular de oxígeno (SvyO2), diferencia arteriovenosa yugular de oxígeno (DavyO2), extracción cerebral de oxígeno (ECO2) y tasa metabólica cerebral (TMC). Resultados: La presión arterial de dióxido de carbono descendió progresivamente en ambos grupos mientras se registro un ascenso de la saturación venosa yugular de oxígeno en el transcurso del acto anestésico, acompañado de un descenso de la diferencia arteriovenosa yugular de oxígeno, extracción cerebral de oxígeno y tasa metabólica en los grupos estudiados sin que se constataran diferencias significativas entre estos en los diferentes momentos estudiados (p> 0,05). Conclusiones: El clorhidrato de ketamina a dosis analgésicas puede ser utilizado de forma segura en anestesia neuroquirúrgica para tumores supratentoriales, sin que provoque un incremente el metabolismo cerebral.
Introduction: Increasing consumption of oxygen and of cerebral blood flow, as well as of intracranial pressure, are adverse effects limiting the use of Ketamine hydrochloride in neurosurgical anesthesia; however, nowadays its use is reassessed because of its main principle is the neuroprotection. Material and Methods: Authors studied 40 patients operated on by craniotomy diagnosed with supratentorial tumors which had intravenous total anesthesia combined with Fentanyl and Ketamine hydrochloride to secure analgesia in each group. We registered the arterial carbon dioxide tension (PaCO2), oxygen jugular venous saturation (SvyO2), oxygen jugular arteriovenous difference (DavyO2), oxygen cerebral extraction (ECO2), and the cerebral metabolic rate (CMT). Results: The arterial tension of carbon dioxide fall progressively in both groups while there was a rise of oxygen jugular venous saturation during anesthetic procedure with a fall of oxygen jugular arteriovenous difference, oxygen cerebral extraction, and metabolic rate in the study groups without presence of significant differences in different study times (p < 0,05). Conclusions: Ketamine hydrochloride in analgesic doses may be used in a safe way in neurosurgical anesthesia for supratentorial tumors, without increase in cerebral metabolism.
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Functional magnetic resonance imaging(fMRI) is a very powerful method to understand the mechanism of brain function with non-invasive localization, high spatial and temporal resolution. The essential fMRI technique is blood oxygen level dependent (BOLD-fMRI). Basic principles and methodological applications of BOLD-fMRI are reviewed in this paper.
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BACKGROUND: To investigate the effects of topiramate (TPM) or lamotrigine (LTG) on cerebral glucose metabolism, we performed 18F-fluorodeoxy glucose positron emission tomography (FDG-PET) before and after medication in patients with drug naive idiopathic generalized epilepsy. METHODS: Thiry-three patients with newly diagnosed as idiopathic generalized epilepsy (IGE) or IGE without antiepileptic drugs after diagnosis were included. Pre- and post-antiepileptic drug FDG-PET were performed (before and after TPM or LTG administration) in 33 subjects treated with TPM or LTG who had been seizure free for at least 8 weeks. Sixteen of patients received TPM (M/F=8/8, aged 29.2+/-12.3 years) and 17 LTG (M/F=8/9, 26.8+/-9.3 years). For statistical paramateric (SPM) analysis, all PET images were spatially normalized to the standard PET template and then smoothed using a 12-mm full width at half-maximum Gaussian kernel. The paired t-test was used to compare pre- and post-medication FDG-PET images. RESULTS: SPM analysis of post- and pre-medication FDG-PETs showed TPM reduced glucose metabolism markedly in the thalamus, corpus callosum, and white matters, whereas LTG decreased glucose metabolism in cortico-striato-entorhinal areas with a false discovery rate corrected p<0.05. No brain region showed post-medication hypermetabolism in either group. CONCLUSION: Our study demonstrates that both TPM and LTG affect the cerebral glucose metabolism in drug naive idiopathic generalized epilepsy patients.
Subject(s)
Humans , Anticonvulsants , Brain , Corpus Callosum , Diagnosis , Epilepsy , Epilepsy, Generalized , Glucose , Immunoglobulin E , Metabolism , Positron-Emission Tomography , Seizures , ThalamusABSTRACT
PURPOSE: To investigate the effects of topiramate on cerebral glucose metabolism, we performed 18F-fluorodeoxy glucose positron emission tomography (FDG-PET) in patients with new-onset epilepsy. METHODS: Thirteen patients with new-onset epilepsy or without medication after epilepsy diagnosis were included. Pre- and post-drug FDG-PET were performed (before and after topiramate administration) in all subjects (M/F=9/4, 28.2+/-11.4 years). For SPM analysis, paired pre- and linearly transformed post-drug FDG-PETs were spatially normalized into a standard PET template, provided in SPM-99, using a 12-parameter affine and a non-linear transformation. Spatially normalized images were then smoothed by convolution using an isotopic Gaussian kernel with a 14 mm full width at half maximum. The paired t-test was used to compare pre- and post-drug PET images. RESULTS: Mean dose of topiramate at the time of post-drug FDG-PET scanning was 163+/-71 mg. Mean duration of topiramate administration was 169+/-54 days. Responses to topiramate medication were seizure free in 7, reduced seizures in 3, and no changes in 3 patients. Reported adverse events were headache in 2 patients. SPM analysis between post-drug and pre-drug FDG-PET images showed post-drug hypometabolism in the white matters of both parietal and right temporal lobes, and corpus callosum, both thalami, right cingulate gyrus, left midbrain, both superior frontal gyri, left middle frontal gyrus, right inferior- and left superior parietal lobules, and left inferior temporal gyrus (corrected p<0.05). No brain region showed post-drug hypermetabolism. CONCLUSION: Topiramate reduced glucose metabolism more in the corpus callosum, thalamus and white matters, and less in the cerebral cortex.
Subject(s)
Humans , Brain , Cerebral Cortex , Corpus Callosum , Diagnosis , Epilepsy , Glucose , Gyrus Cinguli , Headache , Mesencephalon , Metabolism , Positron-Emission Tomography , Rabeprazole , Seizures , Temporal Lobe , ThalamusABSTRACT
BACKGROUND: Recent studies have demonstrated that cerebral desaturation during rewarming period of CPB was associated with postoperative neurologic dysfunction. The prevention of cerebral desaturation during CPB may reduce the incidences of neurologic and neuropsychological complications. The present study was prospectively undertaken to compare the clinical effects between two strategies (hypercapnic CPB and high flow CPB) to prevent cerebral desaturation for establishing a proper CPB technique. MATERIAL AND METHOD: Thirty-six adult patients scheduled for elective cardiac surgery were randomized into either hypercapnic (PaCO2 45~50 mmHg, n=18) or high flow group (flow rate 2.75 L/m2/min and PaCO2 35~40 mmHg, n=18) during rewarming period of CPB. In each patient, middle cerebral artery blood flow velocity (VMCA), cerebral arteriovenous oxygen content difference (C(a-v)O2), modified cerebral metabolic rate for oxygen (MCMRO2), cerebral oxygen transport rate (TEO2), incidence of cerebral desaturation (internal jugular bulb blood oxygen saturation < or =50%), increased rate of S-100 beta concentration, and arterial and internal jugular bulb blood gas were measured during the five phases of the operation; Pre-CPB, CPB-10 min (steady-state CPB, nasopharyngeal temperature 29~30 degrees C), Rewarm-1 (rewarming phase, nasopharyngeal temperature 33 degrees C), Rewarm-2 (nasopharyngeal temperature 37 degrees C), and CPB-off. Incidence of postoperative delirium and duration were assessed in all patients. All variables were compared between the two groups. RESULT: VMCA (157.88+/-10.87 vs 120.00+/-6.18%, p=0.006), internal jugular bulb O2 saturation (68.01+/-2.75 vs 61.28+/-2.87%, p=0.03) and O2 tension (41.01+/-2.25 vs 32.02+/-1.67 mmHg, p=0.03), and TEO2 (110.84+/-7.41 vs 81.15+/-8.11%, p=0.003) at rewarming periods were higher in the hypercapnic group than in the high flow group. C(a-v)O2 (4.0+/-0.30 vs 4.84+/-0.38 mg/dL, p=0.04), COE (0.36+/-0.03 vs 0.42+/-0.03, p=0.04), increased rate of S-100 beta(391.67+/-23.40 vs 940.0+/-17.02%, p=0.003), and incidence of cerebral desaturation (2 vs 4 patients, p= 0.04) at rewarming periods, and duration of postoperative delirium (18 vs 34 hr, p=0.02) were low in the hypercapnic group compared to the high flow group. CONCLUSION: These results indicate that hypercapnic CPB may provide relatively diminished cerebral injury and beneficial effects for cerebral metabolism relatively compared to high flow CPB.
Subject(s)
Adult , Humans , Blood Flow Velocity , Cardiopulmonary Bypass , Delirium , Hypercapnia , Incidence , Metabolism , Middle Cerebral Artery , Neurologic Manifestations , Oxygen , Prospective Studies , Rewarming , Thoracic SurgeryABSTRACT
BACKGROUND: Moderate hypothermic cardiopulmonary bypass (CPB)has commonly been used in cardiac surgery.Several cardiac centers recently practice normothermic CPB in cardiac surgery.However,the clinical effect and safety of normothermic CPB on cerebral metabolism are not established and not fully understood.This study was prospectively designed to evaluate the clinical influence of normothermic CPB on brain metabolism and to compare it with that of moderate hypothermic CPB. MATERIAL AND METHOD: Thirty-six adult patients scheduled for elective cardiac surgery were randomized to receive normothermic(nasopharyngeal temperature>34.5 degrees C,n=18)or hypothermic (nasopharyngeal temperature 29~30 degrees C,n=18)CPB with nonpulsatile pump.Middle cerebral artery blood flow velocity(VMCA), cerebral arteriovenous oxygen content difference (CAVO2),cerebral oxygen extraction (COE),modified cerebral metabolic rate for oxygen (MCMRO2),cerebral oxygen transport (TEO2),cerebral venous desaturation (oxygen saturation in internal jugular bulb blood < or =50 %),and arterial and internal jugular bulb blood gas analysis were measured during six phases of the operation:Pre-CPB (control),CPB-10 min,Rewarm-1 (nasopharyngeal temperature 34 degrees Cin the hypothermic group),Rewarm-2 (nasopharyngeal temperature 37 degrees Cin the both groups),CPB-off and Post-CPB (skin closure after CPB-off). Postoperaitve neuropsychologic complications were observed in all patients.All variables were compared between the two groups. RESULT: VMCA at Rewarm-2 was higher in the hypothermic group (153.11 +/-8.98%)than in the normothermic group (131.18 +/-6.94%) (p<0.05).CAVO (2) (3.47 +/-0.21 vs 4.28 +/-0.29 mL/dL,p<0.05),COE (0.30 +/-0.02 vs 0.39 +/-0.02,p<0.05)and MCMRO (2) (4.71 +/-0.42 vs 5.36 +/-0.45,p<0.05)at CPB-10 min were lower in the hypothermic group than in the normothermic group.The hypothermic group had higher TEO (2) than the normothermic group at CPB-10 (1,527.60 +/-25.84 vs 1,368.74 +/-20.03, p<0.05),Rewarm-2 (1,757.50 +/-32.30 vs 1,478.60 +/-27.41,p<0.05)and Post-CPB (1,734.37 +/-41.45 vs 1,597.68 +/-27.50,p<0.05).Internal jugular bulb oxygen tension (40.96 +/-1.16 vs34.79 +/-2.18 mmHg,p<0.05),saturation (72.63 +/-2.68 vs 64.76 +/-2.49 %,p<0.05)and content (8.08 +/-0.34 vs 6.78 +/-0.43 mL/dL,p<0.05)at CPB-10 were higher in the hypothermic group than in the normothermic group.The hypothermic group had less incidence of postoperative neurologic complication (delirium)than the normothermic group (2 vs 4 patients,p<0.05). Lasting periods of postoperative delirium were shorter in the hypothermic group than in the normothermic group (60 vs160 hrs,p<0.01). CONCLUSION: These results indicate that normothermic CPB should not be routinely applied in all cardiac surgery,especially advanced age or the clinical situations that require prolonged operative time. Moderate hypothermic CPB may have beneficial influences relatively on brain metabolism and postoperative neuropsychologic outcomes when compared with normothermic CPB.
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Adult , Humans , Blood Gas Analysis , Brain , Cardiopulmonary Bypass , Cerebral Arteries , Delirium , Hypothermia , Incidence , Metabolism , Operative Time , Oxygen , Prospective Studies , Thoracic SurgeryABSTRACT
In the past decade, major advances have been made in defining and, to some extent, quantifying the types of brain damage that occur in non-missile head injury, and in identifying their pathogenesis, using biological models of head injury. There have been various approaches to the classification of brain damage and we have tended to emphasize the existence of primary and secondary damage from impairment of cerebral blood flow and brain metabolism, which helps in the identification of at least potentially preventable complications.
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Brain , Classification , Craniocerebral Trauma , Metabolism , Models, BiologicalABSTRACT
In 30 patients subjected to craniotomy for cerebral aneurysm, the correlation of cerebral blood flow and cerebral metabolism were evaluated by measuring mean arterial pressure (MAP) and cerebral arterio-venous oxygen content differences(AVDO2) during isoflurane and neurolept anesthesia. 15 patients were given 1 MAC isoflurane anesthesia and 15 patients neurolept anesthesia. MAP, AVDO2 and PaCO2 were measured before skin incision, after skin incision, after opening of dura and after closing of dura. The results were as follows: 1) In both groups, significant increases in MAP was observed after skin incision(P<0.05), no significant difference between the two groups was found. 2) In both groups, significant decreases in AVDO2 was observed after skin incision (<0.05), AVDO, values showed insignificant difference. The results indicate that even moderate increases in MAP after skin incision during isoflurane and neurolept anesthesia affect AVDO2 values, suggesting increases in cerebral blood flow. Therefore measures that prevent increase in MAP during incision should be implemented. The study suggests that isoflurane anesthesia is as useful as neurolept anesthesia in terms of AVDO2 to patients undergoing aneurysmal surgery.