title: Effects of Ginkgo biloba extract on cerebral oxygen and glucose metabolism in elderly patients with pre-existing cerebral ischemia.
abstract: OBJECTIVE
  Cerebral injury caused by hypoperfusion during the perioperative period is one of the main causes of disability and death in patients after major surgery. No effective protective or preventative strategies have been identified. This study was designed to evaluate the effects of Ginkgo biloba extract on cerebral oxygen and glucose metabolism in elderly patients with known, pre-existing cerebral ischemia.
  
  
  METHODS
  Sixty ASA (American Society of Anesthesiologists) II-III patients, diagnosed with vertebral artery ischemia by transcranial Doppler ultrasonography (TCD), and scheduled for elective total hip replacement surgery, were enrolled in the study. They were randomly allocated to receive either 1mg/kg Ginkgo biloba extract (G group n=30) or normal saline (D group n=30) after induction of anesthesia. Blood samples were collected from radial artery and jugular venous bulb catheters for blood gas analysis and determination of glucose and lactate concentrations preoperatively, before surgical incision, at the end of surgery, and on post-op day 1. Arterial O2 content (CaO2), jugular venous O2 content (CjvO2), arteriovenous O2 content difference (Da-jvO2), cerebral oxygen extraction rate (CEO2), and arteriovenous glucose and lactate content differences (Da-jvGlu and Da-jvLac) were calculated.
  
  
  RESULTS
  There were no significant differences in CaO2 or Da-jvGlu during surgery between groups (p>0.05). However, the Ginkgo group had higher CjvO2, internal jugular venous oxygen saturation (SjvO2) and lower CEO2, Da-jvO2 and Da-jvLac at the end of surgery (T2) and on post-op day 1 (T3) than those in the control group (p<0.05).
  
  
  CONCLUSIONS
  Ginkgo biloba extract can improve cerebral oxygen supply, decrease cerebral oxygen extraction rate and consumption, and help maintain the balance between cerebral oxygen supply and consumption. It has no effect, however, on cerebral glucose metabolism in elderly patients with known, pre-existing cerebral ischemia.
authors.affiliation: Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
authors.forename: Lili
authors.initials: L
authors.lastname: Xu
authors.affiliation: Department of Anesthesiology, The Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, China. Electronic address: huzhiyong777@126.com.
authors.forename: Zhiyong
authors.initials: Z
authors.lastname: Hu
authors.affiliation: Department of Anesthesiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Jianjun
authors.initials: J
authors.lastname: Shen
authors.affiliation: Department of Anesthesiology, Penn State Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: McQuillan
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D002545:Brain Ischemia / Q000097:blood* / Q000188:drug therapy*; D002560:Cerebrovascular Circulation / Q000187:drug effects; D005260:Female; D020441:Ginkgo biloba / Q000737:chemistry*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D008517:Phytotherapy; D010936:Plant Extracts / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D001786:Blood Glucose; D010936:Plant Extracts; D010100:Oxygen
keywords: Brain; Cerebral ischemia; Ginkgo biloba extract; Glucose