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J Thorac Cardiovasc Surg 1998;115:1350-1357
© 1998 Mosby, Inc.

CARDIOPULMONARY SUPPORT AND PHYSIOLOGY

Selective convective brain cooling during normothermic cardiopulmonary bypass in dogs

Dr. Wass was awarded a Research Fellow Scholarship and Grant from Augustine Medical, Inc., Eden Prairie, Minn., to support this research project. All scholarship and grant moneys were received by the Mayo Foundation for Research and Education.

This work was presented at the Midwest Anesthesia Residents' Conference and at Outcomes '97.

Received for publication May 6, 1997 Revisions requested July 21, 1997; revisions received Dec. 17, 1997 Accepted for publication Dec. 17, 1997. Address for reprints: C. Thomas Wass, MD, Department of Anesthesiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905.

Abstract

Objective: Although normothermic cardiopulmonary bypass results in improved cardiac outcome, patients do not benefit from hypothermia-mediated brain protection and thus may be at high risk for ischemic brain injury. The present study evaluated the efficacy of selective forced-air cerebral cooling.
Methods: Sixteen dogs were anesthetized with either intravenous pentobarbital or inhaled halothane (n = 8 for each group). Temperatures were monitored in the esophagus (i.e., core), parietal epidural space, and brain parenchyma. Normothermic atrial-femoral cardiopulmonary bypass and forced-air pericranial cooling (to approximately 13° C) were maintained for 150 minutes. Data between groups were compared by means of repeated-measures analysis of variance and two-sample t test. Within each group, brain-to-core temperature gradients were compared to zero by means of the one-sample t test.
Results: In pentobarbital-anesthetized dogs, after 30 minutes of cerebral cooling, temperatures in the parietal epidural space and 1 cm and 2 cm beneath the dura were 3.3° ± 1.4° C (mean ± standard deviation), 2.6° ± 1.3° C, and 1.1° ± 0.6° C cooler than the core temperature, respectively. At the conclusion of the study (i.e., 150 minutes), these temperatures were 4.5° ± 1.8° C, 3.9° ± 1.6° C, and 2.0° ± 0.9° C cooler than the core temperature, respectively. Similar changes were observed in halothane-anesthetized dogs.
Conclusions: Regardless of the background anesthetic, the magnitude of selective cerebral cooling observed in our study was larger than the 1° to 2° C changes previously reported to modulate ischemic brain injury. (J Thorac Cardiovasc Surg 1998;115:1350-7)

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