Optimal blood flow for cooled brain at 20°C

Watanabe, Takao; Oshikiri, Naoshi; Inui, Kiyoshige; Kuraoka, Setsuo; Minowa, Takashi; Hosaka, Jun; Takahashi, Tetsuya; Shimazaki, Yasuhisa

doi:10.1016/s0003-4975(99)00561-5

Cited by 20 publications

(13 citation statements)

References 19 publications

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“…Using the alpha‐stat strategy of pH management, Watanabe et al demonstrated in a dog model that cerebrovascular autoregulation is maintained to a lower pressure limit of 20 mmHg during perfusion at “moderate hypothermia” (temperature 20°C), with the estimated requirement for cerebral blood flow being 25% to 30% of that at normothermia 14 . Kazui et al have confirmed the safety of moderate hypothermia (22°C) with ACP at arterial pressures 40 to 70 mmHg in clinical studies 1,7 …”

Section: Discussionmentioning

confidence: 98%

Aortic Arch Reconstruction: Safety of Moderate Hypothermia and Antegrade Cerebral Perfusion During Systemic Circulatory Arrest

et al. 2006

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Section: Discussionmentioning

confidence: 98%

Aortic Arch Reconstruction: Safety of Moderate Hypothermia and Antegrade Cerebral Perfusion During Systemic Circulatory Arrest

et al. 2006

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“…In dogs cerebral metabolic ratio of glucose to oxygen and the cerebral vascular resistance were lowest when perfusion pressure was 10-30 mmHg. Full-flow (100 mL kg Ϫ1 min Ϫ1 ) perfusion caused paradoxical brain acidosis; a flow of 40 mL kg Ϫ1 min Ϫ1 provided the best results [32].…”

Section: Discussionmentioning

confidence: 99%

Monitoring of selective antegrade cerebral perfusion using near infrared spectroscopy in neonatal aortic arch surgery

Hofer¹,

Haizinger²,

Geiselseder³

et al. 2005

European Journal of Anaesthesiology

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“…Their initial development during cooling induction prior to the arrest has been recognized but disregarded. Development of intracellular acidosis at 20°C, even without circulatory arrest [4], and post-DHCA functional impairment correlation with duration of the hypothermic perfusion prior to arrest [5] have been reported with alpha-stat management. Both facts further support our view: hypoxic metabolism (Bohr effect) caused by hypothermia and exacerbated by the hypocarbic alkalosis starts well before arrest.…”

Section: Ph-stat Management Is More Appropriate During Deep Hypothermmentioning

confidence: 98%

pH-Stat management is more appropriate during deep hypothermia, especially when circulatory arrest is added

Miyamoto

2000

Journal of Anesthesia

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during cooling and rewarming with proper pH management, since patients do not go from 38° to 18°C or vice versa instantaneously.The better postoperative neurologic outcome following deep hypothermic perfusion in infants with pH-stat than with alpha-stat management is known [9], and probably results from less hypoxia-induced excitotoxicity and minimization of NO generation than with alpha-stat strategies.With the use of eucapnic or slightly hypercapnic ventilation (expired [CO 2 ] of 5.1% to 5.7% providing pH of 7.23-7.1, PaCO 2 of 50-60 mmHg, and PaO 2 of 230-260 mmHg, uncorrected for temperature, equivalent to normoxic pH-stat hypothermic cardiopulmonary bypass), spinal cord function in rabbits after 1 h of ischemia was consistently preserved by surface-induced hypothermia to only 29.5°C [10], which is considered too high a temperature if 1 h of ischemia is to be protected with alpha-stat hypothermia [11].Mild acidosis decreases Ca 2ϩ influx, glutamate neurotoxicity, and neuronal injury from deprivation of oxygen and glucose by reducing the activation of NMDA receptors [12][13][14][15]. Alkalosis sensitizes neurons to ischemia and exacerbates excitotoxicity, potentiating reperfusion injury [15,16], which is the scenario with alpha-stat DHCA.Eucapnic ventilation can usually be maintained with minimal changes in respiratory rate down to temperatures of 32°-33°C. The alpha-stat strategy might be preferable for temperatures Ͼ32°C, at which most coronary bypass operations are performed, but the pH-stat strategy is probably more physiologic for temperatures Ͻ32°C [10], regardless of whether conditions are normoxic or hyperoxic [17,18], particularly if circulatory arrest is being contemplated.

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Optimal blood flow for cooled brain at 20°C

Cited by 20 publications

References 19 publications

Aortic Arch Reconstruction: Safety of Moderate Hypothermia and Antegrade Cerebral Perfusion During Systemic Circulatory Arrest

Aortic Arch Reconstruction: Safety of Moderate Hypothermia and Antegrade Cerebral Perfusion During Systemic Circulatory Arrest

Monitoring of selective antegrade cerebral perfusion using near infrared spectroscopy in neonatal aortic arch surgery

pH-Stat management is more appropriate during deep hypothermia, especially when circulatory arrest is added

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