Neurophysiologic effects of retrograde cerebral perfusion used for aortic reconstruction.
OBJECTIVE
The results of neurophysiologic monitoring using somatosensory evoked potentials (SSEPs) and electroencephalography (EEG) were analyzed to determine if retrograde cerebral perfusion (RCP) supported central nervous system electrical function during surgery that required temporary interruption of antegrade cerebral perfusion (IACP).


METHODS
A prospective, observational study.


METHODS
A university hospital.


METHODS
Fifteen adult patients who underwent aortic reconstruction using RCP and three patients who underwent thoracic aortic operations using hypothermic circulatory arrest without RCP.


METHODS
SSEPs and EEG were monitored continuously throughout the operation. Regression analysis was performed to determine the factors that affected the rate of decrease in SSEP amplitudes during IACP and the time required for SSEP and EEG activity to recover after antegrade cerebral perfusion (ACP) was restored.


RESULTS
The amplitude of SSEPs that were elicited decreased over time after IACP. The mean +/- standard deviation (SD) time required for the brachial plexus (Erb's point), cervicomedullary junction (N13), and brainstem (N18) SSEPs to decrease to 0.5 of their original amplitude after IACP were 30 +/- 2, 19 +/- 2, and 16 +/- 2 minutes, respectively. The rate of decrease in the N18 SSEP amplitude after IACP correlated positively to the fraction of no-flow time (p = 0.01).


CONCLUSIONS
RCP attenuated the rate of decay in SSEP amplitudes during IACP. This suggested that RCP had a measurable physiologic effect on central nervous system function and may increase the time that ACP can be safely interrupted.
Cheung
A T
AT
Department of Anesthesiology, University of Pennsylvania, Philadelphia 19104-4283, USA.
Bavaria
J E
JE
Weiss
S J
SJ
Patterson
T
T
Stecker
M M
MM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery*; D001783:Blood Flow Velocity; D001921:Brain / Q000502:physiology*; D002545:Brain Ischemia / Q000503:physiopathology / Q000517:prevention & control; D002315:Cardiopulmonary Bypass; D002560:Cerebrovascular Circulation; D004569:Electroencephalography; D005073:Evoked Potentials, Somatosensory; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D010477:Perfusion / Q000379:methods*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures