a comparison of cerebral and venous microdialysis during experimental hypothermic antegrad cerebral...
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![Page 1: A comparison of cerebral and venous microdialysis during experimental hypothermic antegrad cerebral perfusion. Authors: Jonsson O, Tovedal T, Zemgulis](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649ce55503460f949b3299/html5/thumbnails/1.jpg)
A comparison of cerebral and venous microdialysis during experimental hypothermic antegrad cerebral perfusion.
Authors:Jonsson O, Tovedal T, Zemgulis V, Lennmyr F, Hillered L,
Thelin S.
Department of Cardiothoracic surgery and anesthesiologyDepartment of Neuroscience, Neurosurgery
Uppsala University Uppsala University Hospital, Sweden
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SACP Selective Antegrade Cerebral Perfusion
A Carotis communis
Aortic cannula
Clamps
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Microdialysis
Lactate/pyruvate
Lactate/glucose
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Background
• To encircle any signs of energy metabolic crisis and cellular distress during SACP flows between 6 ml/kg/min and 4 ml/kg/min.
• Can intravenous microdialysis in the sagittal sinus reveal global cerebral metabolic changes not detected by the brain microdialysis catheter.
![Page 5: A comparison of cerebral and venous microdialysis during experimental hypothermic antegrad cerebral perfusion. Authors: Jonsson O, Tovedal T, Zemgulis](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649ce55503460f949b3299/html5/thumbnails/5.jpg)
Aims
• To investigate the effects of two SACP flow levels (6 and 4 ml/kg/min) on the development of cerebral ischemia.
• To evaluate the agreement and correlation between microdialysis markers harvested from the brain and the sagittal sinus.
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Method
• Randomized study• 3 groups• 18 pigs (0 excluded)• Microdialysis (Cerebral, Sinus sagittal)• NIRS (Near infrared spectroscopy)• Cooling temperature 20oC
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Experimental protocol
Group 1(○) SACP 4 ml/kg/min increased to 6 ml/kg/min/
Group 2 (∆) SACP 6 ml/kg/min decreased to 4 ml/kg/min
Group 3 (●) Control
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0 30 60 90 120 150 1800
50
100
150
CPBCooling SACP SACP
S vO 2A
Time (min)
%
0 30 60 90 120 150 18060
80
100
120
140
CPBCooling SACP SACP
TOI relative
* *
B
Time (min)
%
0 30 60 90 120 150 1800
20
40
60
80
100
CPBCooling SACP SACP
MAPC
Time (min)
mm
Hg
0 30 60 90 120 150 1800
5
10
15
CPBCooling SACP SACP
Blood lactate
* *
D
Time(min)
µmol
/l
ResultsNIRS tissue oxygen index (TOI)
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ResultsMicrodialysis from the brain
0 30 60 90 120 150 1800
2
4
6
A. Glucose CNSCPB
Cooling SACP SACP
Time (min)
mm
ol/l
0 30 60 90 120 150 1800
2
4
6
8
CPBCooling
SACP SACP
B. Lactate CNS
*
Time (min)
mm
ol/l
0 30 60 90 120 150 1800
100
200
300
CPBCooling SACP SACP
C. Pyruvate CNS
*
Time (min)
µmol
/l
0 30 60 90 120 150 1800
20
40
60
80
CPBCooling SACP SACP
D. L/P ratio CNS
*
Time (min)
0 30 60 90 120 150 1800
50
100
150
E. Glutamate CNSCPB
Cooling SACP SACP
Time (min)
µmol
/l
0 30 60 90 120 150 1800
50
100
150
200
250
CPBCooling SACP SACP
F. Glycerol CNS
Time (min)
µmol
/l
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Results Microdialysis from the sagittal sinus
0 30 60 90 120 150 1800
5
10
15
A. Glucose SSCPB
Cooling SACP SACP
Time (min)
mm
ol/l
0 30 60 90 120 150 1800
2
4
6
8
10
12
CPBCooling SACP SACP
B. Lactate SS
Time (min)
mm
ol/l
0 30 60 90 120 150 1800
100
200
300
CPBCooling SACP SACP
C. Pyruvate SS
Time (min)
µmol
/l
0 30 60 90 120 150 1800
20
40
60
80
100
120
CPBCooling SACP SACP
D. L/P ratio SS
Time (min)
0 30 60 90 120 150 1800
50
100
150
200
250
CPBCooling SACP SACP
E. Glutamate SS
Time (min)
µmol
/l
0 30 60 90 120 150 1800
200
400
600
800
CPBCooling SACP SACP
F. Glycerole SS
*
*
Time (min)
µmol
/l
Probably the effect of circulatory arrest
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Results Bland Altman
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Results Correlation and Agreement
Table 3. Spearman’s correlation, bias, and limits of agreement between cerebral and sagittal sinus MD samples (n=119).
Comparison Correlation (r) Bias Limits of agreement p value
Glucose 0.41 - 3.8 - 9.2 to + 1.6 <0.01
Lactate 0.25 - 2.1 - 6.6 to + 4.5 0.08
Pyruvate - 0.02 - 35.7 -179.4 to + 108.0 0.87
Urea 0.32 - 0.7 - 2.2 to + 0.8 0.02
L/P ratio - 0.02 - 5.8 -49.0 to + 37.4 0.88
L/G ratio 0.15 2.0 - 6.3 to + 10.4 0.30
Glutamate 0.11 - 49.0 -152.9 to + 54.9 0.45
Glycerol 0.03 80.9 -71.4 to + 233.3 0.85
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Conclusion
• An SACP flow of 6 ml/kg/min preserves cerebral metabolism according to cerebral microdialysis and NIRS.
• An SACP flow of 4 ml/kg/min induces early signs of disturbed energy metabolism.
• Microdialysis from the sagittal sinus is a feasible methode for monitoring biomarkers of global cerebral perturbations,
• But in the present model correlation with parenchymal measurements were poor and no agreement could be demonstrated.