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Eur J Cardiothorac Surg 2001;20:979-985
© 2001 Elsevier Science NL

Arterial blood gas management in retrograde cerebral perfusion: the importance of carbon dioxide

Department of Cardiothoracic Surgery, University of Tokyo, Tokyo, Japan

Received 30 May 2001; received in revised form 25 July 2001; accepted 30 July 2001.

Corresponding author. Department of Cardiothoracic Surgery, University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo 113-0033, Japan. Tel.: +81-3-3815-5411, ext. 33321; fax: +81-3-5684-3989
e-mail: kueno-tky{at}umin.ac.jp

Objectives: Many interventional physiological assessments for retrograde cerebral perfusion (RCP) have been explored. However, the appropriate arterial gas management of carbon dioxide (CO₂) remains controversial. The aim of this study is to determine whether alpha-stat or pH-stat could be used for effective brain protection under RCP in terms of cortical cerebral blood flow (CBF), cerebral metabolic rate for oxygen (CMRO₂), and distribution of regional cerebral blood flow. Methods: Fifteen anesthetized dogs (25.1±1.1 kg) on cardiopulmonary bypass (CPB) were cooled to 18°C under alpha-stat management and had RCP for 90 min under: (1), alpha-stat; (2), pH-stat; or (3), deep hypothermic (18°C) antegrade CPB (antegrade). RCP flow was regulated for a sagittal sinus pressure of around 25 mmHg. CBF was monitored by a laser tissue flowmeter. Serial analyses of blood gas were made. The regional cerebral blood flow was measured with colored microspheres before discontinuation of RCP. CBF and CMRO₂ were evaluated as the percentage of the baseline level (%CBF, %CMRO₂). Results: The oxygen content of arterial inflow and oxygen extraction was not significantly different between the RCP groups. The %CBF and %CMRO₂ were significantly higher for pH-stat RCP than for alpha-stat RCP. The regional cerebral blood flow, measured with colored microspheres, tended to be higher for pH-stat RCP than for alpha-stat RCP, at every site in the brain. Irrespective of CO₂ management, regional differences were not significant among any site in the brain. Conclusions: CO₂ management is crucial for brain protection under deep hypothermic RCP. This study revealed that pH-stat was considered to be better than alpha-stat in terms of CBF and oxygen metabolism in the brain. The regional blood flow distribution was considered to be unchanged irrespective of CO₂ management.

Key Words: Retrograde cerebral perfusion • Alpha-stat • pH-stat • Deep hypothermia • Carbon dioxide

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