JTCS Tips for Better Browsing
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Reich, D. L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Reich, D. L.

J Thorac Cardiovasc Surg 1999;118:570
© 1999 Mosby, Inc.

Letters to the Editor

Is alpha-stat management still justified for deep hypothermic circulatory arrest in adults?

David L. Reich, MD

Professor of Anesthesiology
Mount Sinai School of Medicine
One Gustave L. Levy Place
New York, NY 10029-6574

Reply to the Editor:

We wish to thank Miyamoto and Miyamoto for their thoughtful letter in response to our recent publication regarding neuropsychologic outcome after deep hypothermic circulatory arrest (DHCA). In their discussion of the controversy of pH-stat versus alpha-stat blood gas management, they raised several important issues and ideas for future investigation.

There are several potential explanations for the association between DHCA of more than 25 minutes’ duration and late neuropsychologic dysfunction in our study. Although we cannot rule out alpha-stat management, we believe that factors such as longer cerebral ischemia, more complex aortic repairs, and more advanced atheromatous disease in elderly patients were more likely causes. Additionally, the extrapolation of animal models of neuronal protection to the clinical scenario of adult aortic reconstruction is problematic.

We have no immediate plans to use pH-stat blood gas management in patients undergoing DHCA for aortic reconstruction. We firmly believe, however, that improved modalities of cerebral protection will arise eventually from experimental models and clinical investigation, including the important contributions of Miyamoto and Miyamoto, among others.

12/8/100287




This article has been cited by other articles:


Home page
 Ann. Thorac. Surg.Home page
T.-A. Miyamoto and K.-J. Miyamoto
Prevention of post-hypothermic circulatory arrest temporary neurologic deficits
Ann. Thorac. Surg., November 1, 2000; 70(5): 1764 - 1765.
[Full Text] [PDF]

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Reich, D. L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Reich, D. L.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS