JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (9) Citing Articles via Google Scholar Google Scholar Articles by Homi, H. M. Articles by Grocott, H. P. Search for Related Content PubMed PubMed Citation Articles by Homi, H. M. Articles by Grocott, H. P. Related Collections Cardiovascular Heart Neuroanesthesia Monitoring (Non-cardiac)

---

CARDIOVASCULAR ANESTHESIA

Hemodilution During Cardiopulmonary Bypass Increases Cerebral Infarct Volume After Middle Cerebral Artery Occlusion in Rats

H. Mayumi Homi, MD^*, Hong Yang, MD^*, Robert D. Pearlstein, PhD^*, and Hilary P. Grocott, MD

Departments of *Surgery and Anesthesiology (Multidisciplinary Neuroprotection Laboratories), Duke University Medical Center, Durham, North Carolina

Address correspondence and reprint requests to Hilary P. Grocott, MD, Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC 27710. Address e-mail to h.grocott{at}duke.edu

Although the optimal hematocrit during cardiopulmonary bypass (CPB) is not defined, excessive hemodilution may lead to organ ischemia via a reduction in oxygen-carrying capacity uncompensated by autoregulatory and/or rheologic increases in organ blood flow. As a result, the consequences of hemodilution in patients at risk for cerebral ischemia are not clearly understood. We designed this study to evaluate the effects of hemodilution in the setting of focal cerebral ischemia during CPB. Wistar rats surgically prepared for CPB were randomized to either hemodilution (hemoglobin (Hb), 6 g/dL; n = 9) or control (Hb, 11 g/dL; n = 8) groups and subsequently exposed to focal cerebral ischemia induced by middle cerebral artery occlusion (MCAO). Immediately after the onset of MCAO (maintained for 90 min), 65 min of hypothermic (28°C) CPB was initiated. Twenty-four hours later, functional neurological outcome and cerebral infarct volume were determined. Compared with controls, the hemodilution group had worse neurological performance (new score = 8 [2], hemodilution; versus 10 [2], control; P = 0.030) and larger total cerebral infarct volumes (182 ± 84 mm³, hemodilution; versus 103 ± 58 mm³, control; P = 0.043). In this experimental model of CPB with reversible MCAO-induced focal cerebral ischemia, hemodilution worsened neurological function and increased cerebral infarct volume.

IMPLICATIONS: Hemodilution (hemoglobin, 6 g/dL) increased cerebral infarct volume and worsened outcome after focal cerebral ischemia during cardiopulmonary bypass in rats; this suggests that excessive hemodilution may increase the risk of cardiac surgery-related stroke.

This article has been cited by other articles:

				G. M. T. Hare, A. K. Y. Tsui, A. T. McLaren, T. E. Ragoonanan, J. Yu, and C. D. Mazer Anemia and Cerebral Outcomes: Many Questions, Fewer Answers Anesth. Analg., October 1, 2008; 107(4): 1356 - 1370. [Abstract] [Full Text] [PDF]

				K. Charette, Y. Hirata, A. Bograd, L. Mongero, J. Chen, J. Quaegebeur, and R. Mosca 180 ml and less: Cardiopulmonary bypass techniques to minimize hemodilution for neonates and small infants Perfusion, September 1, 2007; 22(5): 327 - 331. [Abstract] [PDF]

				G. M. T. Hare, C. D. Mazer, J. S. Hutchison, A. T. McLaren, E. Liu, A. Rassouli, J. Ai, R. E. Shaye, J. A. Lockwood, C. E. Hawkins, et al. Severe hemodilutional anemia increases cerebral tissue injury following acute neurotrauma J Appl Physiol, September 1, 2007; 103(3): 1021 - 1029. [Abstract] [Full Text] [PDF]

				C. D. Mazer, F. Briet, K. R. Blight, D. J. Stewart, M. Robb, Z. Wang, A. M. Harrington, W. Mak, X. Li, and G. M.T. Hare Increased cerebral and renal endothelial nitric oxide synthase gene expression after cardiopulmonary bypass in the rat J. Thorac. Cardiovasc. Surg., January 1, 2007; 133(1): 13 - 20. [Abstract] [Full Text] [PDF]

				A. T. McLaren, P. A. Marsden, C. D. Mazer, A. J. Baker, D. J. Stewart, A. K. Y. Tsui, X. Li, Y. Yucel, M. Robb, S. R. Boyd, et al. Increased expression of HIF-1{alpha}, nNOS, and VEGF in the cerebral cortex of anemic rats Am J Physiol Regulatory Integrative Comp Physiol, January 1, 2007; 292(1): R403 - R414. [Abstract] [Full Text] [PDF]

				G. J. Murphy and G. D. Angelini Indications for Blood Transfusion in Cardiac Surgery Ann. Thorac. Surg., December 1, 2006; 82(6): 2323 - 2334. [Abstract] [Full Text] [PDF]

				G. M. T. Hare, J. M. A. Worrall, A. J. Baker, E. Liu, N. Sikich, and C. D. Mazer {beta}2 Adrenergic antagonist inhibits cerebral cortical oxygen delivery after severe haemodilution in rats Br. J. Anaesth., November 1, 2006; 97(5): 617 - 623. [Abstract] [Full Text] [PDF]

				P. Diprose, M. J. Herbertson, D. O'Shaughnessy, C. D. Deakin, and R. S. Gill Reducing allogeneic transfusion in cardiac surgery: a randomized double-blind placebo-controlled trial of antifibrinolytic therapies used in addition to intra-operative cell salvage Br. J. Anaesth., March 1, 2005; 94(3): 271 - 278. [Abstract] [Full Text] [PDF]

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