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Anesth Analg 2008; 106:795-803
© 2008 International Anesthesia Research Society
doi: 10.1213/ane.0b013e31816173b4
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PEDIATRIC ANESTHESIOLOGY

Measurement of Blood Flow Index During Antegrade Selective Cerebral Perfusion with Near-Infrared Spectroscopy in Newborn Piglets

Patrick Meybohm, MD*{dagger}, Grischa Hoffmann, MD{ddagger}, Jochen Renner, MD*{dagger}, Andreas Boening, MD{ddagger}, Erol Cavus, MD*, Markus Steinfath, MD*, Jens Scholz, MD*, and Berthold Bein, MD, DEAA*{dagger}

From the *Department of Anaesthesiology and Intensive Care Medicine, {dagger}Pediatric Anesthesia Research Unit, and {ddagger}Department of Cardiac and Vascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Germany.

Address correspondence and reprint requests to Dr. Patrick Meybohm, Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, 24105 Kiel, Germany. Address e-mail to meybohm{at}anaesthesie.uni-kiel.de.

Abstract

BACKGROUND: Neonates with complex congenital heart defects have traditionally undergone surgery during deep hypothermic cardiac arrest (HCA). Selective cerebral perfusion (SCP) is thought to minimize ischemic brain injury by providing adequate cerebral blood flow. We investigated SCP with different flow rates compared with HCA with respect to cerebral perfusion and tissue oxygenation as assessed by near-infrared spectroscopy.

METHODS: Twenty-one piglets were placed on cardiopulmonary bypass at 18°C, then underwent either HCA or SCP at 25 or 50 mL · kg–1 · min–1 for 90 min. The blood flow index (BFI) derived by indocyanine green and tissue oxygen index (TOI) were determined by near-infrared spectroscopy. Mean cerebral blood flow velocity (FVmean) was recorded by transcranial Doppler ultrasound.

RESULTS: Both BFI and FVmean increased significantly (126 ± 27% of baseline; 19 ± 2 cm/s) in the SCP 50 group compared with HCA (no flow) and SCP 25 (65 ± 24%; 10 ± 1 cm/s), respectively. TOI increased in the SCP 50 group compared with baseline (74 ± 4% vs 65 ± 4%), and was higher compared with HCA (52 ± 2%) and SCP 25 (59 ± 2%). Intracranial pressure increased nonsignificantly compared with baseline in the SCP 50 group.

CONCLUSIONS: Both BFI and FVmean suggested increased cerebral perfusion in the SCP 50 group compared with the HCA and SCP 25 groups. TOI was significantly higher in both the SCP 25 and SCP 50 groups compared with HCA. SCP at 25 mL · kg–1 · min–1 may be most appropriate for cerebral protection.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2008 by the International Anesthesia Research Society.