Session 4Cerebral metabolic suppression during hypothermic circulatory arrest in humans
Section snippets
Clinical protocol
Thirty-seven patients undergoing nonemergent operations on the ascending aorta or arch utilizing an interval of DHCA between January 31, 1996 and April 16, 1997 were included in the analysis. Anesthesia was induced and maintained with high-dose opioids, 100% oxygen, and muscle relaxant technique, supplemented with isoflurane and midazolam as needed to maintain hemodynamic stability. Intraoperative monitoring included an intraarterial catheter, a pulmonary artery catheter placed via an internal
Results
The demographic characteristics of the population are reported in Table 1. An interval of selective cerebral perfusion was used in 5 (14%) patients for an average of 37 minutes. A brief interval of retrograde perfusion to flush air and debris from the open aorta was used in 6 (16%) patients for an average interval of 7 ± 3 min. A more prolonged period of retrograde cerebral perfusion was used in 13 (35%) of patients, with an average duration of 25 ± 7 min.
The physiologic variables and cerebral
Comment
We found Q10, the metabolic coefficient for the adult human brain during cooling to profoundly hypothermic temperatures, to be 2.3. The relationship between CMRO2 and temperature best fit a log-linear model over the temperature range investigated. The theoretical “safe” duration for hypothermic circulatory arrest derived from our data fit closely with observed clinical experience 1, 8, implying that hypothermic metabolic suppression is a major protective mechanism for the brain during intervals
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