Postoperative brain complications following retrograde cerebral perfusion

Abstract

This study was undertaken to investigate the neurological risk factors associated with the retrograde cerebral perfusion (RCP) technique, by examining the relationship between intraoperative parameters and post-operative brain complications. A total of 12 patients who underwent surgery for thoracic aortic aneurysms using the RCP technique were included in this study. Profound hypothermia was induced through cardiopulmonary bypass which was established with a femoral arterial cannula and bicaval return. During RCP, a venous drainage cannula from the superior vena cava (SVC) was switched over to the arterial return circuit, and oxygenated blood was retrogradely infused through the SVC. The perfusion flow rate was maintained at 273 +/- 113 ml/min and the SVC pressure was maintained at 15 +/- 6 mmHg. The RCP time was 68 +/- 27 min with a range of 27-130 min, and the lowest rectal temperature was 16 +/- 1 degrees C. The total elapsed time until emergence from anesthesia after the operation was 12 +/- 6 h. The operation time correlated with the awakening time (r = 0.729, P = 0.0088). Longer RCP times of up to 101 and 130 min tended to result in post-operative brain damage. The lowest rectal temperature also correlated with the awakening time (r = 0.697, P = 0.0149), and an inverse correlation between the SVC pressure and the awakening time was observed (r = -0. 727, P = 0.0091). These findings demonstrate the importance of reducing both the RCP and operation times to decrease the incidence of brain damage. If carried out under optimal conditions, including perfusion pressure and brain temperature, RCP could be marginally prolonged safely without causing major neurological complications.

Analysis of the Factors Related to a Decrease in Jugular Venous Oxygen Saturation in Patients with Diabetes Mellitus During Normothermic Cardiopulmonary Bypass

“…[1][2][3][4] Thourani et al 2 reported the incidence of the perioperative neurological complications to be more frequent in diabetic patients than in patients without diabetes. However, the precise mechanisms of postoperative cognitive dysfunction in diabetic patients after cardiac surgery are still not fully understood.…”

“…However, the precise mechanisms of postoperative cognitive dysfunction in diabetic patients after cardiac surgery are still not fully understood. [1][2][3][4] The possible mechanisms of postoperative cognitive dysfunction are cerebral ischemia or cerebral desaturation due to hypoperfusion during cardiopulmonary bypass (CPB). 1,5,6 Croughwell et al 6 reported that lower values for internal jugular venous oxygen hemoglobin saturation (SjvO 2 ) at the end of rewarming were associated with cognitive deficits at 4-8 days after surgery.…”

Management of potential gas embolus during closure of an atrial septal defect in a three-year-old

“…10 In both of these studies, cerebral edema was not detected as it was in the previous dog model. Still, another adult study by Sato et al 11 found a negative correlation between SVC pressure during RCP for thoracic aortic aneurysm repair and delayed emergence from anesthesia. Interestingly, the SVC pressures in this study had a mean of 159/6 mmHg and no patient exceeded 23 mmHg.…”

Determinantes de complicações neurológicas no uso da circulação extracorpórea (CEC)

“…This method has advantages over conventional techniques, because it helps maintain uniform hypothermia by using a different method of perfusate administration. It also has a mechanism of oxygen and metabolic substrate supply, and acts in the removal of toxic metabolites and carbon dioxide, in addition to preventing cerebral embolization with air, atheromatous plaques, thrombi or other cell and tissue debris 43 .…”