The role of CPB management in neurobehavioral outcomes after cardiac surgery.

Recent developments in techniques for managing cardiopulmonary bypass are outlined with a view toward interventions aimed at decreasing the incidence of perioperative central nervous system dysfunction and overt stroke. Recent reports assessing central nervous system dysfunction after hypothermic and normothermic cardiopulmonary bypass are reviewed and critiqued along with data assessing techniques for cerebral protection during hypothermic circulatory arrest. Controversy surrounding optimal pH management is explored along with a proposal that pH-stat may be most satisfactory to ensure better brain cooling where circulatory arrest is anticipated, whereas alpha-stat may avoid cerebral hyperemia and thus decrease the cerebral embolic load during moderate hypothermic cardiopulmonary bypass. Newer developments in cerebral monitoring techniques are also reviewed.

[1]  R. L. Maulsby,et al.  Brain protection via cerebral retrograde perfusion during aortic arch aneurysm repair. , 1993, The Annals of thoracic surgery.

[2]  C. Bodian,et al.  Hypothermic circulatory arrest in operations on the thoracic aorta. Determinants of operative mortality and neurologic outcome. , 1994, The Journal of thoracic and cardiovascular surgery.

[3]  A. Weyland,et al.  Acid-base management during hypothermic cardiopulmonary bypass does not affect cerebral metabolism but does affect blood flow and neurological outcome. , 1992, British journal of anaesthesia.

[4]  J. H. Gibbon,et al.  Application of a mechanical heart and lung apparatus to cardiac surgery. , 1954, Minnesota medicine.

[5]  M. Tsuji,et al.  Effects of pH on brain energetics after hypothermic circulatory arrest. , 1993, The Annals of thoracic surgery.

[6]  A. Buchan,et al.  A randomized study of the influence of perfusion technique and pH management strategy in 316 patients undergoing coronary artery bypass surgery. I. Mortality and cardiovascular morbidity. , 1995, The Journal of thoracic and cardiovascular surgery.

[7]  M. D. Ambra Is intraoperative echocardiography a useful monitor in the operating room , 1993 .

[8]  F. Loop,et al.  Primary myocardial revascularization. Trends in surgical mortality. , 1984, The Journal of thoracic and cardiovascular surgery.

[9]  M. Tsuji,et al.  Effects of cerebroplegic solutions during hypothermic circulatory arrest and short-term recovery. , 1994, The Journal of thoracic and cardiovascular surgery.

[10]  Weller Ro,et al.  Brain damage after profoundly hypothermic circulatory arrest : correlations between neurophysiologic and neuropathologic findings : an experimental study in vertebrates , 1993 .

[11]  G. Guiraudon,et al.  Cerebral Autoregulation and Flow/Metabolism Coupling during Cardiopulmonary Bypass: The Influence of Paco2 , 1987, Anesthesia and analgesia.

[12]  T. Orszulak,et al.  A prospective, randomized comparison of cerebral venous oxygen saturation during normothermic and hypothermic cardiopulmonary bypass. , 1994, The Journal of thoracic and cardiovascular surgery.

[13]  K. Kitaguchi,et al.  Internal Jugular Bulb Blood Velocity as a Continuous Indicator of Cerebral Blood Flow during Open Heart Surgery , 1994, Anesthesiology.

[14]  W. White,et al.  Pulsatile versus nonpulsatile reperfusion improves cerebral blood flow after cardiac arrest. , 1993, The Annals of thoracic surgery.

[15]  B. Siesjö,et al.  The Influence of Mild Body and Brain Hypothermia on Ischemic Brain Damage , 1990, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[16]  A. Gjedde,et al.  Arterial line filtration protects brain microcirculation during cardiopulmonary bypass in the pig. , 1994, The Journal of thoracic and cardiovascular surgery.

[17]  M. Kuro,et al.  Accuracy of continuous jugular bulb venous oximetry during cardiopulmonary bypass. , 1993, Anesthesia and analgesia.

[18]  M. Kanchuger,et al.  Superiority of transesophageal echocardiography in detecting aortic arch atheromatous disease: identification of patients at increased risk of stroke during cardiac surgery. , 1994, Journal of cardiothoracic and vascular anesthesia.

[19]  M D Ginsberg,et al.  Effect of mild hypothermia on ischemia-induced release of neurotransmitters and free fatty acids in rat brain. , 1989, Stroke.

[20]  J. Wolbers Brain swelling and coronary artery bypass surgery , 1994, The Lancet.

[21]  T. Sueda,et al.  Retained intracardiac air in open heart operations examined by transesophageal echocardiography. , 1993, The Annals of thoracic surgery.

[22]  R. Lesser,et al.  Superior cerebral protection with profound hypothermia during circulatory arrest. , 1993, The Annals of thoracic surgery.

[23]  W. Weintraub,et al.  Prospective, randomized trial of retrograde warm blood cardioplegia: myocardial benefit and neurologic threat. , 1994, The Annals of thoracic surgery.

[24]  A. Buchan,et al.  A randomized study of the influence of perfusion technique and pH management strategy in 316 patients undergoing coronary artery bypass surgery. II. Neurologic and cognitive outcomes. , 1995, The Journal of thoracic and cardiovascular surgery.

[25]  G. Gravlee,et al.  Response of Cerebral Blood Flood to Changes in Carbon Dioxide Tension during Hypothermic Cardiopulmonary Bypass , 1986, Anesthesiology.

[26]  Relation of pH strategy and developmental outcome after hypothermic circulatory arrest. , 1993 .

[27]  G. Bydder,et al.  Brain swelling in first hour after coronary artery bypass surgery , 1993, The Lancet.