Preservation of static and dynamic cerebral autoregulation after mild hypothermic cardiopulmonary bypass.
BACKGROUND
Dysfunction of cerebral autoregulation might contribute to neurological morbidity after cardiac surgery. In this study, our aim was to assess the preservation of cerebral autoregulation after cardiac surgery involving cardiopulmonary bypass (CPB).


METHODS
Dynamic and static components of cerebral autoregulation were evaluated in 12 patients undergoing coronary artery bypass graft surgery, anaesthetized with midazolam, fentanyl, and propofol, and using mild hypothermic CPB (31-33 degrees C). Arterial pressure (ABP), central venous pressure (CVP), and blood flow velocity in the middle cerebral artery (CBFV) were recorded. The cerebral perfusion pressure (CPP) was calculated as a difference between mean ABP and CVP. Rapid decrease of CPP was caused by a sudden change of patients' position from Trendelenburg to reverse Trendelenburg. Cerebral vascular resistance (CVR) was calculated by dividing CPP by CBFV. Index of static cerebral autoregulation (CAstat) was calculated as the change of CVR related to change of CPP during the manoeuvre. Dynamic rate of autoregulation (RoRdyn) was determined as the change in CVR per second during the first 4 s immediately after a decrease in CPP, related to the change of CPP. Measurements were obtained after induction of anaesthesia, and 15, 30, and 45 min after termination of CPB.


RESULTS
No significant changes were found in CAstat or RoRdyn after CPB. Significant changes in CVR could be explained by concomitant changes in body temperature and haematocrit.


CONCLUSIONS
Autoregulation of cerebral blood flow remains preserved after mild hypothermic CPB.
Preisman
S
S
Department of Anesthesiology and Intensive Care, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Israel. preisman@netvision.net.il
Marks
R
R
Nahtomi-Shick
O
O
Sidi
A
A
D000368:Aged; D019162:Anesthetics, Combined; D001783:Blood Flow Velocity; D002315:Cardiopulmonary Bypass; D002536:Cerebral Arteries / Q000502:physiology*; D005260:Female; D005283:Fentanyl; D006400:Hematocrit; D006706:Homeostasis; D006801:Humans; D007035:Hypothermia / Q000503:physiopathology*; D007036:Hypothermia, Induced; D008297:Male; D008874:Midazolam; D008875:Middle Aged; D009483:Neuropsychological Tests; D015742:Propofol; D012039:Regional Blood Flow; D018709:Statistics, Nonparametric
D019162:Anesthetics, Combined; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol