Changes in cerebral oxygenation during cold (28°C) and warm (34°C) cardiopulmonary bypass using different blood gas strategies (alpha‐stat and pH‐stat) in patients undergoing coronary artery bypass graft surgery

Ali, Mohamed; Harmer, M.; Vaughan, R. S.; Dunne, John Anthony; Latto, I. P.; Haaverstad, Rune; Kulatilake, E. N. P.; Butchart, Eric G.

doi:10.1111/j.1399-6576.2004.00436.x

Cited by 15 publications

(5 citation statements)

References 38 publications

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“…Sixty-four percent of all patients (27) showed QEEG deterioration; in 29% (12), it was unchanged; and in 7% (3), it was improved: 2 in the ketamine-midazolam group and 1 in the sufentanil group. The mean values of all parameters deteriorated significantly, but the largest changes were observed in the following: Δdelta% = −25% ± 36% (p < 0.0001), Δtheta% = −24% ± 23% (p < 0.0001), and ΔAAI% = −20% ± 28% (p = 0.0007).…”

Section: Resultsmentioning

confidence: 99%

“…26 At this institution, CPB is performed at a target temperature of about 30°C with rewarming to normothermia. Using jugular bulb oxygen saturation, Shaaban et al 27 could not show a difference in brain oxygenation between CPB at 28°C and 34°C. Temperature was significantly higher in the sufentanil group before CPB (36.1° ± 0.4°C v 35.6° ± 0.5°C, p = 0.0007) but lower after CPB (36.1° ± 0.4°C v 36.4° ± 0.6°C, p = 0.0323).…”

Section: Discussionmentioning

confidence: 99%

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Anesthetic Technique (Sufentanil Versus Ketamine Plus Midazolam) and Quantitative Electroencephalographic Changes After Cardiac Surgery

Smith

Bartel

Hugo

et al. 2006

Journal of Cardiothoracic and Vascular Anesthesia

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Objectives: Cardiac surgery involving cardiopulmonary bypass is associated with neurologic deterioration. Several interventions, including anesthetic techniques, have been designed to limit ischemic brain damage and have been evaluated in animals. Markers of neurologic injury may facilitate the assessment of these interventions in humans.Design: A blinded randomized prospective study comparing 2 anesthetic techniques (one sufentanilbased, the other ketamine and midazolam-based) in patients undergoing cardiac surgery. Quantitative electroencephalography was used to detect postoperative neurologic injury. Setting: Major teaching hospital.Participants: Forty-two patients aged 18 to 70 years undergoing cardiac surgery.Interventions: Patients were anesthetized with either a sufentanil-based or a ketamine and midazolambased technique for cardiac surgery with cardiopulmonary bypass. Quantitative electroencephalography was performed preoperatively as well as 5 to 6 days postoperatively. Measurements and Main Results:Quantitative electroencephalography outcome did not differ (p > 0.05) between the 2 groups. It showed significant deterioration between preoperative and postoperative assessments with a decrease in faster and an increase in slower frequencies. In addition, the alpha attenuation index decreased. This may reflect a decrease in alertness. Both the intergroup comparisons and the assessment of individual changes failed to reveal significant differences between the anesthetic techniques. The adjuvant use of isoflurane correlated with less deterioration of quantitative electroencephalographic variables. Conclusions:The use of either sufentanil-based or ketamine and midazolam-based anesthetic techniques for cardiac surgery with cardiopulmonary bypass had no effects on a marker of postoperative neurologic injury (ie, quantitative electroencephalography).THE MANIFESTATIONS of cerebral injury after cardiac surgery, to some extent ascribable to the effects of cardiopulmonary bypass (CPB), include postoperative delirium, stroke, and cognitive changes.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Anesthetic Technique (Sufentanil Versus Ketamine Plus Midazolam) and Quantitative Electroencephalographic Changes After Cardiac Surgery

Smith

Bartel

Hugo

et al. 2006

Journal of Cardiothoracic and Vascular Anesthesia

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“…Cognitive dysfunction, delirium, and cerebral vascular accidents are important complications related to CABG surgery performed with CPB (28), and mechanisms include low cerebral perfusion in hypertensive patients with impaired cerebrovascular autoregulation (29, 30). Although the relationship between these neurological complications and cerebral autoregulation in the perioperative period has not been assessed, diminished cerebral blood flow autoregulation during CPB might be harmful (31, 32) and disturbances of cerebral autoregulation during CPB have been reported using 133 Xe clearance (33, 34) and TCD ultrasonography (35, 36). In turn, AT1 receptor antagonists may improve cerebral autoregulation by increasing brain blood flow at a given arterial pressure (10).…”

Section: Discussionmentioning

confidence: 99%

Chronic AT1‐receptor blockade does not alter cerebral oxygen supply/demand ratio during cardiopulmonary bypass in hypertensive patients

Kottenberg-Assenmacher

Massoudy

Jakob

et al. 2007

Acta Anaesthesiol Scand

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“…More recent evidence supports the latter study, suggesting that "cold" CPB has little to offer in terms of better preservation of cerebral oxygenation when compared to "warm" CPB management. 133 The lack of benefit is likely related to mistiming of ischemic insult resulting in cerebral injury and application of hypothermia. Furthermore, accelerated rewarming strategies may worsen neurologic outcomes, as measured by cognitive dysfunction.…”

Section: Temperature Managementmentioning

confidence: 99%

Aortic Arch Atheroma: Stroke Reduction in Cardiac Surgical Patients

Djaiani

2006

Semin Cardiothorac Vasc Anesth

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Cardiac surgery is increasingly performed on elderly patients with extensive coronary artery abnormalities who have impaired left ventricular function, decreased physiologic reserve, and multiple comorbid conditions. Considerable numbers of these patients develop perioperative neurologic complications ranging from subtle cognitive dysfunction to more evident postoperative confusion, delirium, and, less commonly, clinically apparent stroke. Magnetic resonance imaging studies have elucidated that a considerable number of patients have new ischemic brain infarcts, particularly after conventional coronary artery bypass graft surgery. Mechanisms of cerebral injury during and after cardiac surgery are discussed. Intraoperative transesophageal echocardiography and epiaortic scanning for detection of atheromatous disease of the proximal thoracic aorta is paramount in identifying patients at high risk from neurologic injury. It is important to recognize that our efforts to minimize neurologic injury should not be limited to the intraoperative period. Particular efforts should be directed to temperature management, glycemia control, and pharmacologic neuroprotection extending into the postoperative period. Preoperative magnetic resonance angiography may be of value for screening patients with significant atheroma of the proximal thoracic aorta. It is likely that for patients with no significant atheromatous disease, conventional coronary artery revascularization is the most effective long-term strategy, whereas patients with atheromatous thoracic aorta may be better managed with beating heart surgery, hybrid techniques, or medical therapy alone. Patient stratification based on the aortic atheromatic burden should be addressed in future trials designed to tailor treatment strategies to improve long-term outcomes of coronary heart disease and reduce the risks of perioperative neurologic injury.

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Changes in cerebral oxygenation during cold (28°C) and warm (34°C) cardiopulmonary bypass using different blood gas strategies (alpha‐stat and pH‐stat) in patients undergoing coronary artery bypass graft surgery

Abstract: Cold CPB failed to offer any further brain protection in terms of better preservation of cerebral oxygenation than warm CPB. Therefore, warm CPB (34 degrees C) with different blood gas strategies appears to be a satisfactory alternative to cold CPB (28 degrees C).

Cited by 15 publications

References 38 publications

Anesthetic Technique (Sufentanil Versus Ketamine Plus Midazolam) and Quantitative Electroencephalographic Changes After Cardiac Surgery

Anesthetic Technique (Sufentanil Versus Ketamine Plus Midazolam) and Quantitative Electroencephalographic Changes After Cardiac Surgery

Chronic AT1‐receptor blockade does not alter cerebral oxygen supply/demand ratio during cardiopulmonary bypass in hypertensive patients

Aortic Arch Atheroma: Stroke Reduction in Cardiac Surgical Patients

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