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Early cerebral functional outcome after coronary artery bypass surgery using different acid‐base management during hypothermic cardiopulmonary bypass
Author(s) -
Engflhardt W.,
Dierks T.,
Pause M.,
Hartung E.
Publication year - 1996
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.1996.tb04469.x
Subject(s) - medicine , cardiopulmonary bypass , anesthesia , cerebral blood flow , hypothermia , cerebral autoregulation , coronary artery bypass surgery , artery , cardiology , blood pressure , autoregulation
Background : Cerebral injury can render meaningless an otherwise successful cardiac operation. As carbon dioxide management during hypothermic cardiopulmonary bypass has a major impact on cerebral blood flow during bypass, it may also influence postoperative cerebral function. The objective of this prospective, controlled, double‐blind study was to compare the effect of pH‐stat (temperature correction of blood gas analyses) or α‐stat (no temperature correction) on brain function. Methods : Cerebral function was assessed non‐invasively using neurological examination, a neuropsychological test battery, quantitative electroencephalogram and the cognitive evoked potential P300 preoperatively and on postoperative day 7 or 8. Forty‐five patients undergoing elective aortocoro‐nary bypass grafting in barbiturate/opiate anesthesia were randomised into a pH‐stat‐ (n=23) and an α‐stat‐group (n=22). Membrane oxygenators with arterial line filtration and non‐pulsatile flow at a perfussion pressure of 50–60 mmHg were used throughout. Results : One patient in each group developed a new paresis. Among 49 comparisons of cerebral function parameters, only 3 showed significant differences at the 5%‐level, i.e. exactly what is expected purely by chance. These differences were too small to be clinically relevant and favored either pH‐stat (theta‐amplitude) or α‐stat (subtest 3 of syndrome‐short‐test, number of mistakes in aiming). Conclusion : Under the bypass conditions of this study there was no difference in early cerebral functional outcome between pH‐ or α‐stat carbon dioxide management during hypothermic cardiopulmonary bypass.