No abstract

These observations suggest that the pre- and early post-bypass periods are vulnerable times for provision of adequate cerebral oxygenation. Near infrared spectroscopy is a promising tool for monitoring O2 supply/demand relationships especially during circulatory arrest.

We have recorded auditory evoked potentials before and during cardiopulmonary bypass in 10 adult patients undergoing cardiac surgery under moderate hypothermia to 27-28 degrees C. The immediate effect of bypass was a small decrease in latency and increase in amplitude of the early cortical response. We also studied two adults and two children during profound hypothermia with circulatory arrest during cardiopulmonary bypass. Reduction in core temperature to 25 degrees C resulted in an increase in latency and amplitude of the brain stem responses; below this temperature the amplitude decreased but latency continued to increase until the auditory evoked response trace became completely flat between 21 and 19 degrees C. These changes were reversible on rewarming.

We describe a patient who had a cardiac arrest during anaesthesia, in whom regional cerebral oxygen saturation was being measured by near infrared spectroscopy and the auditory evoked responses (AER) were being recorded. Both of these monitors provided useful information on cerebral oxygenation during cardiac arrest. Changes in the AER as the result of either reduced circulation or hypothermia are similar, and should these two situations occur simultaneously there could be difficulty in the interpretation of the AER.

We have compared the Thermomat electric undermattress (JMW Systems, Edinburgh, UK) and the Bair Hugger (Augustine Medical, Courtelary, Switzerland) forced-air warming blanket in 30 adult patients after cardiac surgery. All patients were warmed to an oesophageal temperature of 38 degrees C before termination of cardiopulmonary bypass (CPB); those with oesophageal temperatures < 35.5 degrees C at skin closure were allocated randomly to be rewarmed in the intensive care unit either on the Thermomat (n = 15) or under the Bair Hugger blanket (n = 15), at their highest settings. Oesophageal and lateral thigh skin temperatures were recorded every 15 min for 4 h. There was a significantly faster increase in core temperature (0.5 vs 0.75 degrees C h-1; P < 0.0002) and skin temperature (0.86 vs 1.3 degrees C h-1; P < 0.001) in the Bair Hugger group. However, there was no difference in the number of patients who reached a core temperature of 36 degrees C (15 Bair Hugger, 14 Thermomat) or 37 degrees C (11 Bair Hugger, seven Thermomat), or in the number of patients who reached a skin temperature of 37 degrees C in 4 h (four Bair Hugger, one Thermomat). Twelve patients in the Bair Hugger group reached a skin temperature of 36 degrees C compared with two in the Thermomat group (P < 0.001). The Bair Hugger warmed faster than the Thermomat both centrally and peripherally, and warmed more patients to a core temperature of 37 degrees C in 4 h, but did not reduce the time to tracheal extubation or alter important clinical aspects of postoperative course.