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Query: UMLS:C0020672 (hypothermia)
 17,327 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In order to study the protective effect and problem of retrograde perfusion (RCP), cerebral hemodynamics and cerebral metabolism were evaluated in fourteen pigs weighing 25-30 kg. Intracranial pressure, carotid arterial flow and pressure, and internal jugular venous pressure as cerebral hemodynamics; pyruvate, lactate, and oxygen consumption as cerebral metabolism; and brain temperature were measured. The animal was cooled to electrical cerebral silence on electroencephalogram under cardiopulmonary bypass. Then, animals were divided into three groups: group I (n = 4); circulatory arrest; group II (n = 3); RCP through superior vena cava (SVC); group III (n = 7); RCP through bilateral internal jugular vein (IJV). Retrograde perfusion flow was regulated to maintain the SVC pressure or IJV pressure of 30 mmHg, for 90 minutes. The variations in brain temperature were least in group III. As perfusion flow increased, intracranial pressure, and inferior vena cava (IVC) pressure increased. But, cerebral perfusion pressure, which was calculated from the difference of intracranial arteriovenous pressure, did not increase and, SVC pressure and returned blood flow through the aorta did not increase in group III. In group II, there was no significant relation between pump flow, SVC pressure, and intracranial pressure, but SVC pressure had a positive correlation with the pressure gradient of SVC-IJV. The uptake of cerebral lactate, cerebral pyruvate, and lactate-pyruvate ratio, and cerebral oxygen consumption were superior in group III than other groups. In conclusion, RCP through IJV was advantageous to maintain hypothermia and aerobic metabolism of the brain during systemic hypothermic circulatory arrest.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[The protective effect and problem of retrograde cerebral perfusion]. 805 18

This study was investigated for the effects of pulsatile flow on retrograde cerebral perfusion under profound hypothermic circulatory arrest. Fifteen adult mongrel dogs were placed cardiopulmonary bypass and induced profound hypothermia of 20 degrees C at nasopharyngeal temperature. Five dogs were performed non-pulsatile retrograde cerebral perfusion (NP-RCP) and 5 were pulsatile retrograde cerebral perfusion (P-RCP) for 60 minutes each group. The rest of 5 dogs were performed hypothermic circulatory arrest (HCA) without any circulatory assist. Retrograde cerebral perfusion flow rate was regulated to maintain an external jugular vein pressure of 20 mmHg by infusing oxygenated blood by way of bilateral maxillary vein. Regional cerebral blood flow (rCBF), cerebrospinal fluid pressure (CSFP), adenosine triphosphate (ATP) concentration of cerebral tissue, and water content of cerebral tissue were measured. The rCBF were no statistical difference between the two groups. CSFP and ATP concentration in both of NP-RCP and P-RCP were significantly higher than those of HCA. Water content of cerebral tissue in P-RCP were significantly lower than those of NP-RCP. We concluded that retrograde cerebral perfusion for 60 minutes protects the brain as the assistances of circulatory arrest and retrograde cerebral perfusion with pulsatile flow has the possibility to control brain edema as compared with non-pulsatile flow in dogs.
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PMID:[Experimental studies of pulsatile retrograde cerebral perfusion]. 813 83

Several methods have been used for an adjunct to perform operation of aortic arch aneurysms. However, their results were often not so reasonable. Recently retrograde cerebral perfusion was reported as a new adjunctive method. In our institute, for the past 6 and a half years from May 1985 to April 1992, 50 patients underwent reconstruction of the transverse aortic arch by using two methods of artificial cerebral perfusion. One method is continuous antegrade cerebral perfusion (ACP, for 32 patients), and the other is continuous retrograde cerebral perfusion (RCP, for 18 patients), each technique was combined with deep hypothermia (18-20 degrees C) and low flow perfusion (10-30 ml/kg/min) to lower half body performed from femoral artery. In our RCP circuit, an additional pump was used for cerebral perfusion to superior vena cava, but the circuit was much simpler than the circuit in ACP. We compared the two methods (ACP versus RCP) as regards to the following items and the results were showed in parentheses; hospital death (8/32, 25%: 2/18, 11%), respiratory complication (8.27, 30%: 3/18, 17%), neurological complication (7/29, 24%: 1/18, 5.5%), duration of extracorporeal circulation (306.8 +/- 74.5 min: 260.4 +/- 60.0 min), periods of pre-ECC in the operation (160.3 +/- 69.2 min: 117.7 +/- 35.3 min), duration of cerebral perfusion (113.6 +/- 45.4 min: 74.1 30.5 min) and amount of bleeding (3424 +/- 2881 ml: 1802 +/- 1291 ml). RCP has superior advantages in all of those in comparison with ACP. These results suggest that RCP is a useful adjunctive method for reconstruction of aortic arch with a low operative risk.
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PMID:[Effectiveness of continuous retrograde cerebral perfusion for surgical treatment of aneurysms of the aortic arch--comparison with antegrade cerebral perfusion]. 836 May 32

With the current available information, the use of RCP for cerebral protection during HCA in the clinical setting will continue to be debated. Laboratory evaluation in a variety of animal models has thus far produced conflicting results and a variety of mixed information. Accumulating clinical evidence has confirmed that RCP is safe, provided flow rates and central venous (intracerebral) pressures are maintained at relatively low levels. The use of RCP is clinically safe and does not incur additional expense. In the event that the only clinical benefits of RCP are the maintenance of cerebral hypothermia and the flushing of air and particulate debris from the arterial circulation, consequently reducing the risk of embolism, then the continued use and investigation of RCP techniques is justified.
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PMID:Retrograde cerebral perfusion is an effective means of neural support during deep hypothermic circulatory arrest. 930 19

One-hundred-one surgeries for aortic arch aneurysm were divided into 2 groups: 52 aortic dissection cases (AD) and 49 non-dissecting aneurysm (TA). In group AD, 30 cases were operated in acute phase (acute AD) and 22 were in chronic phase (chronic AD). Preoperative shock were observed in 21 cases (15 in acute AD mostly due to cardiac tamponade, 1 in chronic AD and 5 in TA due to rupture). Through median sternotomy, 59 total arch replacement and 25 hemi-arch replacement were carried out under deep hypothermia (16 degrees C:DH) and retrograde (RCP) or selective (SCP) cerebral perfusion or arch-first technique. Through thoracotomy, distal arch replacement were carried out with DH + RCP in 8 cases and with partial bypass in 9. Early mortality were observed in 7 patients (6.9%) and 24 months survival rates (Kaplan-Meier) were 86.1% overall, 76.1% in acute AD, 95.5% in chronic AD, 87.8% in TA. The survival rates in patients with preoperative shock was 61.2%, however, without shock, 92.9% in acute AD, 95.2% in chronic AD, and 91.4% in TA. Other than mortality, 4 re-operations for aortic arch, 4 operations for descending to abdominal aorta and 1 late hemiplegia were observed. Aortic event free ratio at 24 months was 55.4% in acute AD, 94.4% in chronic AD, and 75.7% in TA. For the further improvement of aortic arch surgery, early mortality and residual false lumen in acute aortic dissection and atherosclerotic aneurysm in descending to abdominal aorta are focused.
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PMID:[Mid-term results of the surgery for aortic arch aneurysm]. 1196 15