Retrograde cerebral perfusion: experimental approach to brain oedema

Oshikiri, Naoshi; Watanabe, Takao; Saitou, Hiroyuki; Iijima, Y; Minowa, Takashi; Inui, Kiyoshige; Shimazaki, Yasuhisa

doi:10.1177/026765919901400404

Cited by 3 publications

(4 citation statements)

References 21 publications

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“…However, some investigators have reported that RCP did not provide neurologic protection at a venous pressure of less than 25 mm Hg in several clinical and experimental studies, [9][10][11][12] and other studies have indicated that high venous pressure might cause brain edema. 2,13 In contrast, Li and colleagues 3 and Estrera and colleagues 2 reported that a venous pressure greater than 30 mm Hg resulted in better tissue oxygenation without tissue edema in an animal model and did not result in brain injury in clinical cases. Thus, it is still unclear whether RCP with a venous pressure of 25 mm Hg is optimum and provides appropriate neurologic protection.…”

Section: Discussionmentioning

confidence: 98%

“…This was achieved using near-infrared spectroscopy (TOS-96; Tostec), because most attenuation of near-infrared light in human cerebral tissues results from absorption by deoxyhemoglobin and deoxyhemoglobin. 13 The determination of rSO 2 is an easy method to assess the real-time adequacy of cerebral perfusion during deep hypothermic time-restricted aortic arch surgery. 13,14 However, rSO 2 measurements can vary with temperature, hemoglobin level, oxygenated blood, and oxygen consumption in the cerebral tissue and anatomy.…”

Section: Discussionmentioning

confidence: 99%

“…13 The determination of rSO 2 is an easy method to assess the real-time adequacy of cerebral perfusion during deep hypothermic time-restricted aortic arch surgery. 13,14 However, rSO 2 measurements can vary with temperature, hemoglobin level, oxygenated blood, and oxygen consumption in the cerebral tissue and anatomy. [15][16][17] Regardless, no significant difference was found in the minimal core temperature or the concentration of oxygen and hemoglobin in the perfused blood to the SVC during RCP between the cRCP and IPA-RCP groups in the present study.…”

Section: Discussionmentioning

confidence: 99%

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Clinical efficacy of intermittent pressure augmented–retrograde cerebral perfusion

Endo

Kubota

Yoshimoto

et al. 2013

The Journal of Thoracic and Cardiovascular Surgery

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During aortic surgery under hypothermic circulatory arrest, retrograde cerebral perfusion (RCP) is commonly used as a cerebroprotective method to extend the duration of circulatory arrest safely. Kitahori and colleagues described a novel protocol of RCP using intermittent pressure augmented (IPA)-RCP in 2005. The aim of the present study was to determine the clinical effectiveness of this novel protocol.Methods: A total of 20 consecutive patients undergoing total replacement of the aortic arch were assigned to a conventional RCP (n ¼ 10) or an IPA-RCP group (n ¼ 10). Cerebral perfusion was provided at a continuous venous pressure of 25 mm Hg in the conventional RCP, and venous pressure was intermittently provided at 20 mm Hg for 120 seconds and at 45 mm Hg for 30 seconds in the IPA-RCP group. The clinical outcomes were compared between the 2 groups. Regional cerebral oxygen saturation (rSO 2 ) was measured using near infrared spectroscopy every 10 minutes from the beginning of RCP initiation. To represent the brain oxygen consumption, the decline ratio of rSO 2 was calculated.Results: There was no surgical mortality or major neurologic complications in either group. The interval from the end of surgery to full wakefulness was significantly shorter in the IPA-RCP group (85 AE 64 minutes) than in the conventional RCP group (310 AE 282 minutes; P<.05). Although the initial rSO 2 value did not show significant difference in both groups, the rSO 2 with IPA-RCP was greater than that with conventional RCP from 10 to 70 minutes (P<.05). The decline ratio of rSO 2 was lower in the IPA-RCP group than in the RCP perfusion group at all points (P <.05).Conclusions: IPA-RCP might provide more homogenous cerebral perfusion and a more effective oxygen supply to the brain with better clinical results than conventional RCP.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical efficacy of intermittent pressure augmented–retrograde cerebral perfusion

Endo

Kubota

Yoshimoto

et al. 2013

The Journal of Thoracic and Cardiovascular Surgery

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show abstract

“…This finding indicates that increased perivascular pressure may play some role in causing delirium after DHCA with RCP. RCP causes cerebral edema in animal models (6,7). Although this trend has not been verified in humans, a central venous pressure (CVP) as high as 35 mmHg is speculated to cause extravasation of fluid from intracranial blood vessels.…”

Section: Pi and Ri Of Ica And Ecamentioning

confidence: 99%