The Oxygen Tension of Cerebrospinal Fluid During Cardiopulmonary Bypass

Hasbrouck, Jan D.; Rigor, Benjamin M.

doi:10.1097/00132586-197104000-00003

Cited by 3 publications

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“…Evidence derived by monitoring cerebral function with a heavily filtered electroencephalograph (Cerebral Function Monitor, Devices Ltd) suggested that the onset of perfusion is a time of particular hazard (Branthwaite, 1973). Microemboli from the extracorporeal apparatus, and inadequate cerebral perfusion caused by an abrupt change in the character and magnitude of the perfusing pressure, could contribute to these findings, and there is experimental and clinical evidence which suggests that both factors may be of importance (Stone et al, 1967;Hasbrouck and Rigor, 1969;Javid et al, 1969;Patterson and Kessler, 1969;Hill et al, 1970;Osborn et al, 1970;Tufo, Ostfeld, and Shekelle, 1970;Egeblad et al, 1972;Sanderson, Wright, and Sims, 1972;Branthwaite, 1974). Since 1970, filters for microemboli have been incorporated into the extracorporeal circuit used in this hospital both on the arterial line (Barrier filter-Johnson and Johnson), and on the coronary suction lines (Bromlus filter-Lusterlite Products Ltd.), and the hazards of sudden hypotension, particularly at the onset of bypass, have been recognized.…”

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Prevention of neurological damage during open-heart surgery.

Branthwaite¹

1975

Thorax

132

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SW3Brauthwaite, M. A. (1975). Thorax, 30,[258][259][260][261]. Prevention of neurological damage during open-heart surgery. A previous study of neurological damage related to openheart surgery suggested that the onset of cardiopulmonary bypass is a time of particular hazard, and there is evidence that both microemboli from the extracorporeal circulation and inadequate cerebral perfusion may be contributory factors.Measures to eliminate or minimize these hazards have been introduced, and a clinical survey has been undertaken to evaluate their efficacy. There has been a very highly significant decrease in the incidence of neurological damage as judged by comparison with the results of a similar survey carried out before these measures were introduced.In spite of limitations imposed by differences in workload, perfusion techniques, and methods of data collection, it is concluded that the prophylactic measures have been responsible for the reduction in the incidence of neurological damage.A previous clinical survey, based upon the retrospective analysis of the case notes of 417 patients submitted to open-heart surgery during 1970, revealed an incidence of neurological damage of 192% (Branthwaite, 1972). Evidence derived by monitoring cerebral function with a heavily filtered electroencephalograph (Cerebral Function Monitor, Devices Ltd) suggested that the onset of perfusion is a time of particular hazard (Branthwaite, 1973). Microemboli from the extracorporeal apparatus, and inadequate cerebral perfusion caused by an abrupt change in the character and magnitude of the perfusing pressure, could contribute to these findings, and there is experimental and clinical evidence which suggests that both factors may be of importance (Stone et al., 1967;Hasbrouck and Rigor, 1969;Javid et al., 1969;Patterson and Kessler, 1969;Hill et al., 1970;Osborn et al., 1970;Tufo, Ostfeld, and Shekelle, 1970;Egeblad et al., 1972;Sanderson, Wright, and Sims, 1972;Branthwaite, 1974 (Figure) or dilatation of the pupils. A second survey was undertaken during 1973 to evaluate the efficacy of these measures. FIGURE Record obtained from the cerebral function monitor at the onset of perfusion in a 43-year-old woman with mild mitral stenosis and hypertension (160/100 mmHg). The arterial blood pressure fell to between 30 and 40 mmHg when the aorta was crossclamped, in spite of a flow of 80 ml/kg per minute from the oxygenator. The resulting cerebral depression was reversed rapidly by the administration of metaraminol (Aramine), and the patient regained consciousness after the operation without any evidence of neurological deficit. Paper speed-6 mm/min. MATERIAL AND METHODSThe case notes of all patients submitted to openheart surgery during 1973 were inspected. The data were collected retrospectively to preserve 258 on 11 May 2018 by guest. Protected by copyright.

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Prevention of neurological damage during open-heart surgery.

Branthwaite¹

1975

Thorax

132

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“…We are aware of only a small number of investigations regarding the blood CSF barrier during CPB 11, 12, 13. There are no systematic research studies evaluating the effects of CPB on the blood CSF barrier in children.…”

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Cardiopulmonary Bypass Increases Permeability of the Blood-Cerebrospinal Fluid Barrier

Okamura

Ishibashi

Zurakowski

et al. 2010

The Annals of Thoracic Surgery

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“…Possible aetiological factors include emboli from within the heart or perfusion apparatus (Allardyce, Yoshida, and Ashmore, 1966;Abrams, 1967;Brierley, 1967;Hill et al, 1969;Bass and Longmore, 1969) and inadequate cerebral perfusion related to hypoxia, hypotension, venous obstruction or malpositioning of intravascular cannulae (Adelman and Jacobson, 1960;Paton, Pearcy, and Swan, 1960;Hasbrouck and Rigor, 1969;Magner, 1971). Profound hypothermia (Bjork and Hultquist, 1960;Drew, 1961) and acute biochemical changes (Michenfelder and Theye, 1969) may contribute in some cases.…”

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Neurological damage related to open-heart surgery: A clinical survey

Branthwaite

1972

Thorax

100

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A survey has been carried out on all cases submitted to open-heart surgery at one hospital during 1970 to determine which operative features were associated with the occurrence of neurological damage.Four hundred and seventeen subjects survived the operative period. Neurological dysfunction, defined as impairment of consciousness, voluntary movement or vision, apparent within three days of operation, was noted in 80 patients (19-2%). Twenty-one of these 80 patients died in the postoperative period, neurological damage contributing to the fatal outcome in 11 cases. The remaining 59 patients survived to leave hospital but 17 were left with some residual neurological disability.A number of features were found to be positively correlated with the development of neurological damage when considered alone, but multiple regression analysis revealed that only three factors were significantly associated, independent of all other variables. These factors were age, duration of perfusion, and a history of previous neurological disorder.The use of a Temptrol oxygenator was associated with a lower incidence of neurological dysfunction to a degree which was probably significant (P<0 02). The small number of patients perfused with the Temptrol oxygenator (30 cases) reduces the clinical importance of this finding.Neurological damage continues to occur following open-heart surgery in spite of changes in both the nature and technique of operation and the method of perfusion.The reported incidence varies (Gilman, 1965;Sachdev, Carter, Swank, and Blachly, 1967;Javid et al., 1969) Jacobson, 1960;Paton, Pearcy, and Swan, 1960;Hasbrouck and Rigor, 1969;Magner, 1971). Profound hypothermia (Bjork and Hultquist, 1960;Drew, 1961)

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The Oxygen Tension of Cerebrospinal Fluid During Cardiopulmonary Bypass

Cited by 3 publications

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Prevention of neurological damage during open-heart surgery.

Prevention of neurological damage during open-heart surgery.

Cardiopulmonary Bypass Increases Permeability of the Blood-Cerebrospinal Fluid Barrier

Neurological damage related to open-heart surgery: A clinical survey

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