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The Journal of Thoracic and Cardiovascular Surgery, Vol 102, 103-114, Copyright © 1991 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
J van der Linden, R Priddy, R Ekroth, C Lincoln, W Pugsley, M Scallan and H Tyden
Flow velocity of the right middle cerebral artery was studied in eight
children during cardiac operations performed with profound hypothermia.
Cerebral oxygen consumption was estimated by relating the difference in
oxygen content between arterial and venous blood (jugular bulb) to flow
velocity. In another six children, also during profound hypothermic
procedures, the diameter of the middle cerebral artery was studied with an
electronic echo-tracking instrument connected to a real-time ultrasound
scanner. Flow velocity and estimated oxygen consumption decreased during
cooling in proportion to the temperature decrease (r = 0.67, p less than
0.001, and r = 0.86, p less than 0.001, respectively), whereas the diameter
was unaffected by temperature. At a nasopharyngeal temperature of 16.9
degrees +/- 1.9 degrees C flow velocity was reduced to 33.1% +/- 7.0% of
the value obtained at 35 degrees C after induction of anesthesia.
Correspondingly, the oxygen consumption decreased to 20.1% +/- 6.4%. The
increase in oxygen consumption per 10 degrees C change in temperature was
3.6 (2.0 to 3.9) during surface cooling, 2.6 (1.9 to 2.7) during
cardiopulmonary bypass cooling, and 2.7 (1.5 to 4.6) during rewarming. Flow
velocity was not influenced by perfusion pressure during profound
hypothermia within the range of 20 to 42 mm Hg (r = 0.14, p = 0.52) but was
related to pump flow (r = 0.73, p less than 0.001). A pump flow down to 0.5
L/min/m2 was found to be adequate during stable profound hypothermia, as
judged from the maintained high jugular bulb venous oxygen saturation (70%
to 80%). It is concluded that flow velocity is reduced at hypothermia in
proportion to the reduced metabolic rate, although modified by other
factors that influence cerebral blood flow.
ARTICLES
Cerebral perfusion and metabolism during profound hypothermia in children. A study of middle cerebral artery ultrasonic variables and cerebral extraction of oxygen
Department of Anaesthesia, University Hospital, Uppsala, Sweden.
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