Hostname: page-component-848d4c4894-x24gv Total loading time: 0 Render date: 2024-05-21T05:19:08.837Z Has data issue: false hasContentIssue false
  • English
  • Français

Cerebral cellular response to profound hypothermia

Published online by Cambridge University Press:  19 August 2008

Takao Watanabe  and
Masahiko Washio
Takao Watanabe*
Affiliation:
From the Second Department of Surgery, Yamagata University School of Medicine, Yamagata
Masahiko Washio
Affiliation:
From the Second Department of Surgery, Yamagata University School of Medicine, Yamagata
*
Dr. Takao Watanabe, The Second Departnent of Surgery, Yamagata University School of Medicine, lidanishi, Yamagata 990-23, Japan. Tel. 0236-33-1122; Fax. 0236-25-9122.
Get access Rights & Permissions [Opens in a new window]

Abstract

In our first two experiments, we examined brain tissue pH and tensions of oxygen and carbon dioxide in dogs core cooled to 20°C. So as to evaluate the effects of 60 minutes of circulatory arrest, 120 minutes of low-flow perfusion (25 mI/kg/mm), and 120 minutes of moderate-flow perfusion (50 mi/kg/mm), all conducted with and without pulsatile assistance. We further determined the effects of blood gas strategy on the same variables with 60 minutes of circulatory arrest. In a third experiment, we directly observed microcirculation at the surface of the brain during profoundly hypothermic perfusion. In the fourth experiment, we measured cerebral blood flow, oxygen consumption, and excessive production of lactate. Profound anoxia occurred within 20 minutes of circulatory arrest, causing severe and progressive acidosis in the brain tissues along with hypercapnia. The inhalation of 5% or 7% carbon dioxide during core cooling made the brain unacceptably acidotic. The brain acidosis was mild with low flow perfusion, and slight with moderate-flow perfusion. Pulsatile assistance improved acidosis in the brain tissues at all rates of flow. It also improved the microcirculation, the patent number of arterioles and stabilized flow in bridging veins. Cerebral metabolism became aerobic without alterations in cerebral consumption of oxygen during low-flow perfusion. We recommend flow rates above 25% of normal, alpha-stat strategy, and pulsatile assistance for better protection of the brain during profound hypothermia.

Keywords

Profoundly hypothermic perfusionpulsatile assistanceblood gas strategybrain cellular acidosisbrain microcirculation
Type
World Forum for Pediatric Cardiology Symposium on Cardiopulmonary Bypass (Part 2)
Information
Cardiology in the Young , Volume 3 , Issue 4 , October 1993 , pp. 383 - 393
Copyright
Copyright © Cambridge University Press 1993

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Kirklin, JW, Pacifico, AD, Hannah, H III, Allarde, RR. Ad vances in Cardiovascular Surgery. Grune & Stratton, New York, 1973, pp 89–90.Google Scholar
2.Watanabe, T, Miura, M, Orita, H, Kobayashi, M, Washio, M. Brain tissue pH, oxygen tension, carbon dioxide tension in profoundly hypothermic cardiopulmonary bypass. J Thorac Cardiovasc Surg 1990; 100: 274–280.CrossRefGoogle ScholarPubMed
3.Watanabe, T, Miura, M, Inui, K, Minowa, T, Shimanuki, T, Nishimura, K, Washio, M. Blood and brain tissue gaseous strategy for profoundly hypothermic total circulatory arrest. J Thorac Cardiovasc Surg 1991; 102: 497–504.CrossRefGoogle ScholarPubMed
4.Michenfelder, JD, Messick, JM JrTheye, RA. Simultaneous cerebral blood flow measured by direct and indirect methods. J Surg Res 1968; 8: 475–481.CrossRefGoogle ScholarPubMed
5.Huckabee, WE. Relationships of pyruvate and lactate during anaerobic metabolism. IV. Local tissue components of total body O2 debt. Am J Physiol 1959; 196: 253–260.CrossRefGoogle ScholarPubMed
6.Muraoka, R, Yokota, M, Aoshima, M, Kyoku, I, Nomoto, S, Kobayashi, A, Nakano, H, Ueda, K, Saito, A, Hojo, H. Subclinical changes in brain morphology following cardiac operations as reflected by computed tomographic scans of the brain. J Thorac Cardiovasc Surg 1981; 81: 364–369.CrossRefGoogle ScholarPubMed
7.Wright, JS, Hicks, RG, Newman, DC. Deep hypothermic arrest: observations on later development in children. J Thorac Cardiovasc Surg 1979; 77: 466–468.CrossRefGoogle ScholarPubMed
8.Wells, FC, Coghill, S, Caplan, HL, Lincoln, C. Duration of circulatory arrest does influence the psychological development of children after cardiac operation in early life. J Thorac Cardiovasc Surg 1983; 86: 823–831.CrossRefGoogle ScholarPubMed
9.Haka-Ikse, K, Blackwood, MJA, Steward, DJ. Psychomotor development ofinfants and children after profound hypother mia during surgery for congenital heart disease. Develop Med Child Neurol 1978; 20: 62–70.CrossRefGoogle Scholar
10.Fisk, GC, Wright, JS, Hicks, RG, Anderson, RM, Turner, BB, Barker, WD, Lawrence, JC, Stacey, RB, Lawrie, GM, Kalnins, I, Rose, M. The influence of duration of circulatory arrest at 20°C on cerebral changes. Anaesth Intens Care 1976; 4: 126–134.CrossRefGoogle Scholar
11.Lunder, T, Froysaker, T, Nornes, H. Cerebral damage following open-heart surgery in deep hypothermia and circulatory ar rest. ScandJ Thorac Cardiovasc Surg 1983; 17: 237–242.CrossRefGoogle Scholar
12.Messmer, BJ, Schallberger, U, Gattiker, R, Senning, A. Psy chomotor and intellectual development after deep hypother mia and circulatory arrest in infancy. J Thorac Cardiovasc Surg 1976; 72: 495–502.CrossRefGoogle Scholar
13.Stevenson, G, Stone, EF, Dillard, DH, Morgan, BC. Intellectual development of children subjected to prolonged circulatory arrest during hypothermic open heart surgery in infancy. Circulation 1974; 50(Suppl II): II 54–II 59.Google ScholarPubMed
14.Dickinson, DF, Sambrooks, JE. Intellectual performance in children after circulatory arrest with profound hypothermia in infancy. Arch Dis Child 1979; 54: 1–6.CrossRefGoogle ScholarPubMed
15.Treasure, TMS, Naftel, DC, Conger, KA, Garcia, JH, Kirklin, JW, Blackstone, EH. The effect of hypothermic circulatory arrest time on cerebral function, morphology, and biochemistry. J Thorac Cardiovasc Surg 1983; 86: 761–770.CrossRefGoogle ScholarPubMed
16.Rossi, RBM, Linden, J, Ekroth, R, Scallan, MMB, Thompson, RJBM, Lincoln, C. No flow or low flow? astudyofthe ischemic marker creatine kinase BB after deep hypothermic procedure. J Thorac Cardiovasc Surg 1989; 98: 193–199.CrossRefGoogle ScholarPubMed
17.Greeley, WJ, Kern, FH, Ungerleider, RM, Boyd, JL III, Quill, T, Smith, LR, Baldwin, BCRNA, Reves, JG. The effect of hypo thermic cardiopulmonary bypass and total circulatory arrest on cerebral metabolism in neonates, infant, and children. J ThoracCardiovasc Surg 1991; 101: 783–794.Google Scholar
18.Steen, PA, Newberg, L, Milde, JH, Michenfelder, JD. Hypothermia and barbiturates: individual and combined effects on canine cerebral oxygen consumption. Anaesthesiology 1983; 58: 527–532.CrossRefGoogle ScholarPubMed
19.Fox, LS, Blackstone, EH, Kirklin, JW, Bishop, SPDVM, Bergdahl, LAL, Bradley, EL. Relationship ofbrain blood flow and oxygen consumption to perfusion flow rate during profoundly hypo thermic cardiopulmonary bypass. J Thorac Cardiovasc Surg 1984; 87: 658–664.CrossRefGoogle Scholar
20.Kramer, RS, Sanders, AP, Lesage, AM, Woodhall, BW, Sealy, WC. The effect of profound hypothermia on preservation of cerebral ATP content during circulatory arrest. J Thorac Cardiovasc Surg 1968; 56: 699–709.CrossRefGoogle ScholarPubMed
21.Swain, JA, MacDonald, TJ Jr, Griffith, PK, Balaban, RS, Clark, RE, Ceckler, T. Low-flow hypothermic cardiopulmonary by pass protects the brain. J Thorac Cardiovasc Surg 1991; 102: 76–84.CrossRefGoogle Scholar
22.Scheller, MS, Branson, PJ, Cornacchia, LG, Alksne, JF. A comparison of the effects on neuronal Golgi morphology, assessed with electron microscopy, of cardiopulmonary by pass, low-flow bypass, and circulatory arrest during profound hypothermia. J Thorac Cardiovasc Surg 1992; 104: 1396–1404.CrossRefGoogle Scholar
23.Matsuda, H, Sasako, Y, Nakano, S, Shirakura, R, Obtani, M, Kaneko, M, Ohtake, S, Kawashima, Y. Determination of opti mal perfusion flow rate for deep hypothermic cardiopulmo nary bypass in the adult based on distributions of blood flow and oxygen consumption. J Thorac Cardiovasc Surg 1992; 103: 541–548.CrossRefGoogle Scholar
24.Shepard, RB, Simpson, DC, Sharp, JF. Energy equivalent pressure. Arch Surg 1966; 93: 730–740.CrossRefGoogle ScholarPubMed
25.Miyamoto, K, Kawashima, Y, Matsuda, H, Okuda, S, Maeda, S, Hirose, H. Optimal perfusion flow rate for the brain during deep hypothermic cardiopulmonary bypass at 20°C. J Thorac Cardiovasc Surg 1986; 92: 1065–1070.CrossRefGoogle Scholar
26.Taylor, RH, Burrows, FA, Bissonnette, B. No flow during low-flow cardiopulmonary bypass. J Thorac Cardiovasc Surg 1991; 101: 362–364.CrossRefGoogle ScholarPubMed
27.Blauth, CI, Arnold, JVBA, Schulenberg, WE, McCartney, AC, Taylor, KM. Cerebral microembolism during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1988; 95: 668–676.CrossRefGoogle ScholarPubMed
28.Thulborn, KR, du Boulay, GH, Duchen, LW, Radda, G. A sip nuclear resonance in vivo study of cerebral ischemia in the gerbil. J Cereb Blood Flow Metab 1982; 2: 299–306.CrossRefGoogle Scholar
29.Norwood, WI, Norwood, CR, lngwall, JS, Casrañeda, AR. Hypothermic circulatory arrest: 31-phosphorus nuclear mag netic resonance of isolated perfused neonatal rat brain. J Thorac Cardiovasc Surg 1978; 78: 823–830.CrossRefGoogle Scholar
30.Axford, TC, Dearani, JA, Khait, I, Park, WM, Patel, MA, Doursounian, M, Neuringer, L, Valeri, CR, Khuri, SF. Electrode-derived myocardial pH measurements reflect intracellu lar myocardial metabolism assessed by phosphorus 31-nuclear magnetic resonance spectroscopy during normothermic ischemia. J Thorac Cardiovasc Surg 1992; 103: 902–907.CrossRefGoogle Scholar
31.Reeves, RB. An imidazole alphastat hypothesis for vertebrate acid-base regulation: tissue carbon dioxide content and body temperature in bullfrogs. Resp Physiol 1972; 14: 219–236.CrossRefGoogle ScholarPubMed
32.Swan, H. The importance of acid-base management for cardiac and cerebral preservation during open heart operations. Surg Gynecol Obstet 1984; 158: 391–414.Google ScholarPubMed
33.Rahn, H, Reeves, RB, Howell, BJ. Hydrogen ion regulation, temperature, and evolution. Am Rev Resp Dis 1975; 112: 165–172.Google ScholarPubMed
34.Marsh, WR, Anderson, RE, Sundt, TM Jr. Effect ofhyperglyce mia on brain pH levels in areas of focal incomplete cerebral ischemia in monkeys. J Neurosurg 1986; 65: 693–696.CrossRefGoogle Scholar
35.Gevers, W. Generation of protons by metabolic processes in heart cells. J Mol Cell Cardiol 1977; 9: 867–874.CrossRefGoogle ScholarPubMed
36.Hillered, L, Ernster, L, Siesjo, BK. Influence of in vitro lactic acidosis and hypercapnia on respiratory activity of isolated rat brain mitochondria. J Cereb Blood Flow Metab 1984; 4: 430–437.CrossRefGoogle ScholarPubMed
37.Rehncrona, S. Brain acidosis. Ann Emerg Med 1985; 14: 770–776.CrossRefGoogle ScholarPubMed
38.Ferry, PC. Neurologic sequelae of open-heart surgery in chil dren. Am J Dis Child 1990; 144: 369–373.CrossRefGoogle Scholar
39.Murkin, JM, Farrar, JK, Tweed, WA, McKcnzie, FN, Guiraudon, G. Cerebral autoregulation and flow/metabolism coupling during cardiopulmonary bypass: the influence of PaCO2. Anesth Anaig 1987; 66: 825–832.Google ScholarPubMed