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The Journal of Thoracic and Cardiovascular Surgery, Vol 97, 737-745, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
WJ Greeley, RM Ungerleider, LR Smith and JG Reves
Cardiopulmonary bypass management in infants and children involves
extensive alterations in temperature, hemodilution, and perfusion pressure,
with occasional periods of circulatory arrest. Despite the use of these
biologic extremes of temperature and perfusion, their effects on cerebral
blood flow are unknown. This study was designed to examine the relationship
of mean arterial pressure and nasopharyngeal temperature to cerebral blood
flow during deep hypothermic cardiopulmonary bypass (18 degrees to 22
degrees C) with and without periods of total circulatory arrest. Cerebral
blood flow was measured before, during, and after deep hypothermic
cardiopulmonary bypass using xenon clearance techniques in 25 children,
aged 2 days to 60 months. Fourteen patients underwent repair with
circulatory arrest. There was a highly significant correlation of cerebral
blood flow with temperature during cardiopulmonary bypass (p = 0.007).
During deep hypothermic bypass there was a significant association between
cerebral blood flow and mean arterial pressure (p = 0.027). In infants
undergoing repair with deep hypothermia alone, cerebral blood flow returned
to prebypass levels in the rewarming phase of bypass. However, in patients
undergoing repair with circulatory arrest, no significant increase in
cerebral blood flow during rewarming or even after bypass was observed (p =
0.01). These data show that deep hypothermic cardiopulmonary bypass
significantly decreases cerebral blood flow because of temperature
reduction. Under conditions of deep hypothermia, cerebral pressure-flow
autoregulation is lost. This study also demonstrates that cerebral
reperfusion after deep hypothermia is impaired if the patient is exposed to
a period of total circulatory arrest.
ARTICLES
The effects of deep hypothermic cardiopulmonary bypass and total circulatory arrest on cerebral blood flow in infants and children
Department of Anesthesiology, Duke Heart Center, Durham, N.C.
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