Anesth Analg 1999;89:1078
© 1999 International Anesthesia Research Society
CARDIOVASCULAR ANESTHESIA
Cerebral Response to Hemodilution During Hypothermic Cardiopulmonary Bypass in Adults
Hulya Sungurtekin, MD*,
David J. Cook, MD ,
Thomas A. Orszulak, MD ,
Richard C. Daly, MD , and
Charles J. Mullany, MD
*Pamukkale University Medical School, Denizli, Turkey; and Departments of
Anesthesiology and
Surgery, Mayo Medical School, Rochester, Minnesota
Address correspondence and reprint requests to David J. Cook, MD, 200 First St., SW, Rochester, MN 55905. Address e-mail to cook.david{at}mayo.edu
We examined the cerebral response to changing hematocrit during hypothermic cardiopulmonary bypass (CPB) in 18 adults. Cerebral blood flow (CBF), cerebral metabolic rate for oxygen (CMRO2), and cerebral oxygen delivery (CDO2) were determined using the nitrous oxide saturation technique. Measurements were obtained before CPB at 36°C, and twice during 27°C CPB: first with a hemoglobin (Hgb) of 6.2 ± 1.2 g/dL and then with a Hgb of 8.5 ± 1.2 g/dL. During hypothermia, appropriate reductions in CMRO2 were demonstrated, but hemodilution-associated increases in CBF offset the reduction in CBF seen with hypothermia. At 27°C CPB, as the Hgb concentration was increased from 6.2 to 8.5 g/dL, CBF decreased. CDO2 and CMRO2 were no different whether the Hgb was 6.2 or 8.5 g/dL. In eight patients in whom the Hgb was less than 6 g/dL, CDO2 remained more than twice CMRO2.
Implications: This study suggests that cerebral oxygen balance during cardiopulmonary bypass is well maintained at more pronounced levels of hemodilution than are typically practiced, because changes in cerebral blood flow compensate for changes in hemoglobin concentration.
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