Effects of cerebral air embolism on brain metabolism in pigs

Hulst, Rob van; Lameris, Thomas W.; Hasan, D.; Klein, Jan; Lachmann, Burkhard

doi:10.1034/j.1600-0404.2003.00100.x

Cited by 23 publications

(23 citation statements)

References 33 publications

(48 reference statements)

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“…We have previously shown a decrease in brain glucose after CAGE in the pig (van Hulst et al, 2003b). These results are in line with the findings in the present study, although the decrease in brain glucose we found was not significant and did not differ between groups.…”

Section: Discussionsupporting

confidence: 87%

“…The techniques used have described before (van Hulst et al, 2003b). In short, after removal of a 2 cm × 3 cm sized scalp flap 39 ± 3 4 0 ± 2 3 9 ± 2 4 0 ± 1 Intracranial pressure (mmHg) 7 ± 2 8 ± 3 2 5 ± 17 a 32 ± 20 a Cerebral perfusion pressure (mmHg) 81 ± 16 87 ± 13 52 ± 28 67 ± 23 a PbrO2 (mmHg) 22 ± 6 2 6 ± 5 1 1 ± 5 a 15 ± 10 a Brain glucose (mmol/l)…”

Section: Intracerebral Probesmentioning

confidence: 99%

“…We have developed a porcine model of CAGE, using clinically relevant measurements such as intracranial pressure (ICP), brain oxygen tension and microdialysis to assess the effects of air embolism on cerebral metabolism (van Hulst et al, 2003b). This model has proven its usefulness in CAGE research (van Hulst et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

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Cerebral arterial gas embolism in swine. Comparison of two sites for air injection

Weenink¹,

Hollmann

Stevens

et al. 2011

Journal of Neuroscience Methods

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Cerebral arterial gas embolism is a risk in diving and occurs as a complication in surgery and interventional radiology. Swine models for cerebral arterial gas embolism have been used in the past. However, injection of air into the main artery feeding the pig brain - the ascending pharyngeal artery - might be complicated by the presence of the carotid rete, an arteriolar network at the base of the brain. On the other hand, anastomoses between external and internal carotid territories are present in the pig. In order to determine the most appropriate vessel for air injection, we performed experiments in which air was injected into either the ascending pharyngeal artery or the external carotid artery. We injected 0.25 ml/kg of room air selectively into the ascending pharyngeal artery or the external carotid artery of 35-40 kg Landrace pigs (n=8). We assessed the effect on cerebral metabolism by measuring intracranial pressure, brain oxygen tension and brain glucose and lactate concentrations using cerebral microdialysis. Intracranial pressure and brain oxygen tension changed significantly in both groups, but did not differ between groups. Brain lactate increased significantly more in pigs in which air was injected into the ascending pharyngeal artery. Intracranial pressure, brain oxygen tension and brain lactate correlated after injection of air into the ascending pharyngeal artery, but not after injection into the external carotid artery. Our model is suitable for investigation of cerebral arterial gas embolism. The ascending pharyngeal artery is the most appropriate vessel for air injection.

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Section: Discussionsupporting

confidence: 87%

Section: Intracerebral Probesmentioning

confidence: 99%

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Cerebral arterial gas embolism in swine. Comparison of two sites for air injection

Weenink¹,

Hollmann

Stevens

et al. 2011

Journal of Neuroscience Methods

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“…Several animal studies have shown that 0.5 mL/kg of intracarotid air was sufficient to cause permanent brain damage (19-21). It has been reported that the degree and type of brain injury are largely dependent on the size of these air bubbles (22).…”

Section: Discussionmentioning

confidence: 99%

In VitroObservation of Air Bubbles during Delivery of Various Detachable Aneurysm Embolization Coils

et al. 2012

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ObjectiveDevice- or technique-related air embolism is a drawback of various neuro-endovascular procedures. Detachable aneurysm embolization coils can be sources of such air bubbles. We therefore assessed the formation of air bubbles during in vitro delivery of various detachable coils.Materials and MethodsA closed circuit simulating a typical endovascular coiling procedure was primed with saline solution degassed by a sonification device. Thirty commercially available detachable coils (7 Axium, 4 GDCs, 5 MicroPlex, 7 Target, and 7 Trufill coils) were tested by using the standard coil flushing and delivery techniques suggested by each manufacturer. The emergence of any air bubbles was monitored with a digital microscope and the images were captured to measure total volumes of air bubbles during coil insertion and detachment and after coil pusher removal.ResultsAir bubbles were seen during insertion or removal of 23 of 30 coils (76.7%), with volumes ranging from 0 to 23.42 mm3 (median: 0.16 mm3). Air bubbles were observed most frequently after removal of the coil pusher. Significantly larger amounts of air bubbles were observed in Target coils.ConclusionVariable volumes of air bubbles are observed while delivering detachable embolization coils, particularly after removal of the coil pusher and especially with Target coils.

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“…when bubbles occlude the brain vasculature, intracranial pressure (IcP) increases and an extremely inhomogenous distribution of blood flow in the brain causes hyperemia and ischemia. An animal study showed that cerebral air embolism is associated with a significant increase in IcP, a significant increase in brain lactate, and partial pressure of brain cO 2 as well as a significant decrease in brain pH (61). Finally, reperfusion injury may cause additional harm once the initial ischemia is resolved (62).…”

Section: Emboli Detection and Classification (Edac)mentioning

confidence: 99%

Generation, Detection and Prevention of Gaseous Microemboli during Cardiopulmonary Bypass Procedure

Lou

Liu

et al. 2011

Int J Artif Organs

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Neuropsychological injury after cardiopulmonary bypass (CPB) is one of the most serious and costly complications arising from the procedure. Gaseous microemboli (GME) have long been implicated as one of the principal causes. There are two major sources of GME: surgical and manual manipulation of the heart and arteries; and the components of the extracorporeal circuit, including the type of pump, different perfusion modes, the design of the oxygenator and reservoir, and the use of vacuum assisted venous drainage (VAVD), all of which have a great impact on the delivery of existing GME to the patients. Transcranial Cranial Doppler (TCD) has been used for more than two decades to assess and monitor the quality of extracorporeal perfusion with regard to the blood flow velocity of the middle cerebral arteries (MCA) and emboli detection, contributing to the achievement of better perfusion results. The Emboli Detection and Classification (EDAC) Quantifier has been able to detect and track microemboli in CPB circuits up to 1,000 microemboli per second at flow rates ranging from 0.2 L/min to 6.0 L/min. The deleterious effects of GME are multiple, including damage to the cerebral vascular endothelium, disruption of the blood-brain barrier, complement activation, leukocyte aggregation, increased platelet adherence, and fibrin deposition in the micro-vasculature. Improvements in perfusion equipment and in perfusion and surgical techniques have led to a dramatic reduction in the occurrence of GME during cardiac surgery. Although the clinical relevance of cerebral air embolization in causing neurological damage is unclear, every single person involved in perfusion and surgical technology should be aware of the risk of embolization and strictly regulate clinical behavior. Related research should also be done to improve the design of circuit components and clinical practice with a view to eliminating air bubbles during CPB procedure.

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Effects of cerebral air embolism on brain metabolism in pigs

Abstract: Cerebral air embolism has a deleterious effect on ICP and brain metabolism. Therefore, this model may be suitable for testing therapeutic regimens in cerebral air embolism.

Cited by 23 publications

References 33 publications

Cerebral arterial gas embolism in swine. Comparison of two sites for air injection

Cerebral arterial gas embolism in swine. Comparison of two sites for air injection

In VitroObservation of Air Bubbles during Delivery of Various Detachable Aneurysm Embolization Coils

Generation, Detection and Prevention of Gaseous Microemboli during Cardiopulmonary Bypass Procedure

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