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Cardene I.V.

 

Cardiopulmonary Bypass and the Brain


John Murdoch, M.D.
Loyola University, Maywood, Illinois

Reviews

1. Aberg T: Signs of brain cell injury during open heart operations: past and present. Ann Thorac Surg 59:1312-5, 1995.

2. Ali MI, Smith PL, Brannan JJ, Taylor KM: Cerebral monitoring during cardiopulmonary bypass. Perfusion 11:299-312, 1996.

*3. Bachet J, Guilmet D, Goudot B, Dreyfus GD, Delentdecker P, Brodaty D, Dubois C: Antegrade cerebral perfusion with cold blood: A 13-year experience. Ann Thorac Surg 67:1874-8, 1999.

4. Barbut D, Gold JP: Aortic atheromatosis and risks of cerebral embolization. J Cardiothorac Vasc Anesth 10:24-30, 1996.

5. Blumenthal JA, Mahanna EP, Madden DJ, White WD, Croughwell ND, Newman MF: Methodological issues in the assessment of neuropsychologic function after cardiac surgery. Ann Thorac Surg 59:1345-50, 1995.

6. Borowicz LM, Goldsborough MA, Selnes OA, McKhann GM: Neuropsychologic change after cardiac surgery: a critical review. J Cardiothorac Vasc Anesth 10:105-11, 1996.

7. Burrows FA: Con: pH-stat management of blood gases is preferable to alpha-stat in patients undergoing brain cooling for cardiac surgery. J Cardiothorac Vasc Anesth 9:219-21, 1995.

8. Burrows FA, Bissonnette B: Monitoring the adequacy of cerebral perfusion during cardiopulmonary bypass in children using transcranial Doppler technology. J Neurosurg Anesthesiol 5:209-12, 1993.

9. Chanyi, S: Cerebral perfusion and hypothermic circulatory arrest. J Cardiothorac Vasc Anesth 10:75-81, 1996.

*10. Cook DJ: Changing temperature management for cardiopulmonary bypass. Anesth Analg 88:1254-71, 1999.

11. Doblar DD: Cerebrovascular assessment of the high-risk patient: the role of transcranial Doppler ultrasound. J Cardiothorac Vasc Anesth 10:3-14, 1996.

*12. du Plessis AJ: Mechanisms of brain injury during infant cardiac surgery. Semin Pediatr Neurol 6:32-47, 1999.

*13. Ergin MA, Griepp EB, Lansman SL, Galla JD, Levy M, Griepp RB: Hypothermic circulatory arrest and other methods of cerebral protection during operations on the thoracic aorta. J Card Surg 9:525-37, 1994.

14. Gazmuri RJ, Becker J: Cardiac resuscitation: the search for hemodynamically more effective methods. Chest 111:712-23, 1997.

15. Gill R, Murkin JM: Neuropsychologic dysfunction after cardiac surgery: what is the problem? J Cardiothorac Vasc Anesth 10:91-8, 1996.

16. Greeley WJ, Kern FH, Meliones JN, Ungerleider RM: Effect of deep hypothermia and circulatory arrest on cerebral blood flow and metabolism. Ann Thorac Surg 56:1464-6, 1993.

17. Hammon JW, Stump DA, Butterworth JB, Moody DM: Approaches to reduce neurologic complications during cardiac surgery. Semin Thorac Cardiovasc Surg 13:184-91, 2001.

18. Heyer EJ, Adams DC: Neurologic assessment and cardiac surgery. J Cardiothorac Vasc Anesth 10:99-103, 1996.

19. Hindman B: Cerebral physiology during cardiopulmonary bypass: pulsatile versus non-pulsatile flow. Adv Pharmacol 31:607-16, 1994.

20. Hornick P, Taylor K: Pulsatile and nonpulsatile perfusion: the continuing controversy. J Cardiothorac Vasc Anesth 11:310-5, 1997.

21. Johnsson P: Markers of cerebral ischemia after cardiac surgery. J Cardiothorac Vasc Anesth 10:120-6, 1996.

22. Jonas RA: Hypothermia, circulatory arrest, and the pediatric brain. J Cardiothorac Vasc Anesth 10:66-74, 1996

*23. Kern FH, Greeley WJ: Pro: pH-stat management of blood gases is not preferable to alpha-stat in patients undergoing brain cooling for cardiac surgery. J Cardiothorac Vasc Anesth 9:215-8, 1995.

*24. Lazar HL, Menzoian JO: Coronary artery bypass grafting in patients with cerebrovascular disease. Ann Thorac Surg 66:968-74, 1998.

25. McLean RF, Wong BI: Normothermic versus hypothermic cardiopulmonary bypass: central nervous system outcomes. J Cardiothorac Vasc Anesth 10:45-52, 1996.

*26. Mills SA: Cerebral injury and cardiac operations. Ann Thorac Surg 56(5 Suppl):S86-91, 1993.

27. Moehle DA; Neuromonitoring in the cardiopulmonary bypass surgical patient: clinical applications. J Extra Corpor Technol 33(2):126-34, 2001.

*28. Moody DM, Brown WR, Challa VR, Stump DA, Reboussin DM, Legault C: Brain microemboli associated with cardiopulmonary bypass: a histologic and magnetic resonance imaging study. Ann Thorac Surg 59:1304-7, 1995.

29. Murkin JM: Attenuation of neurologic injury during cardiac surgery. Ann Thorac Surg  72(5):S1838-44, 2001.

30.  Murkin JM, Stump DA: Res ipsa loquitur: protecting the brain in the new millennium, "Outcomes 2000". Ann Thorac Surg  69(5):1317-8, 2000.

*31. Nathan HJ, Munson J, Wells G, Mundi C, Balaa F, Wynands JE: The management of temperature during cardiopulmonary bypass: effect on neuropsychological outcome. J Card Surg 10(4 Suppl):481-7, 1995.

32. Newman MF, Croughwell ND, Blumenthal JA, Lowry E, White WD, Reves JG: Cardiopulmonary bypass and the central nervous system: potential for cerebral protection. J Clin Anesth 8(3 Suppl):53S-60S, 1996.

33. Newman MF, Croughwell ND, Blumenthal JA, Lowry E, White WD, Spillane W, Davis RD Jr, Glower DD, Smith LR, Mahanna EP, Reves JG: Predictors of cognitive decline after cardiac operation. Ann Thorac Surg 59:1326-30, 1995.

34. Newman SP: Analysis and interpretation of neuropsychologic tests in cardiac surgery. Ann Thorac Surg 59:1351-5, 1995.

35. Nollert G, Jonas RA, Reichart B: Optimizing cerebral oxygenation during cardiac surgery: a review of experimental and clinical investigations with near infrared spectrophotometry. Thorac Cardiovasc Surg  48(4):247-53, 2000.

36. Nollert G, Shin’oka T, Jonas RA: Near-infrared spectrophotometry of the brain in cardiovascular surgery. Thorac Cardiovasc Surg 46:167-175, 1998.

37. Nussmeier NA: Adverse neurologic events: risks of intracardiac versus extracardiac surgery. J Cardiothorac Vasc Anesth 10:31-7, 1996.

38. O'Dwyer C, Prough DS, Johnston WE: Determinants of cerebral perfusion during cardiopulmonary bypass. J Cardiothorac Vasc Anesth 10:54-65, 1996.

39. Pua HL, Bissonnette B: Cerebral physiology in paediatric cardiopulmonary bypass. Can J Anaesth 45:960-978, 1998.

*40. Sebel PS: Central nervous system monitoring during open heart surgery: an update. J Cardiothorac Vasc Anesth 12 (2Suppl 1):3-8, 1998.

41. Siesjö BK, Zhao Q, Pahlmark K, Siesjö P, Katsura K, Folbergrova J: Glutamate, calcium, and free radicals as mediators of ischemic brain damage. Ann Thorac Surg 59:1316-20, 1995.

42. Small DL, Buchan AM: Mechanisms of cerebral ischemia: intracellular cascades and therapeutic interventions. J Cardiothorac Vasc Anesth 10:139-46, 1996.

43. Smith PL: The systemic inflammatory response to cardiopulmonary bypass and the brain. Perfusion 11:196-9, 1996.

44. Stump DA, Rogers AT, Hammon JW, Newman SP, Phil D: Cerebral emboli and cognitive outcome after cardiac surgery. J Cardiothorac Vasc Anesth 10:113-8, 1996.

45. Tallman RD Jr: Acid-base regulation, alpha-stat, and the emperor's new clothes. J Cardiothorac Vasc Anesth 11:282-288, 1997.

46. Taylor KM: Central nervous system effects of cardiopulmonary bypass. Ann Thorac Surg 66:S20-4, 1998.

47. Utley JR: Techniques for avoiding neurologic injury during adult cardiac surgery. J Cardiothorac Vasc Anesth 10:38-44, 1996.

Physiology

  • Temperature
  • Acid-Base Management
  • Flows/Pressure
  • Monitoring

*1. Antognini JF: Hypothermia eliminates isoflurane requirements at 20 degrees C. Anesthesiology 78:1152-6, 1993.

*2. Arom KV, Cohen DE, Strobl FT: Effect of intraoperative intervention on neurological outcome based on electroencephalographic monitoring during cardiopulmonary bypass. Ann Thorac Surg 48:476-83, 1989.

*3. Bashein G, Townes BD, Nessly ML, Bledsoe SW, Hornbein TF, Davis KB, Goldstein DE, Coppel DB: A randomized study of carbon dioxide management during hypothermic cardiopulmonary bypass. Anesthesiology 72:7-15, 1990.

+4. Bashein G, Nessly ML, Bledsoe SW, Townes BD, Davis KB, Coppel DB, Hornbein TF: Electroencephalography during surgery with cardiopulmonary bypass and hypothermia. Anesthesiology 76:878-91, 1992.

*5. Buss MI, McLean RF, Wong BI, Fremes SE, Naylor CD, Harrington EM, Snow WG, Gawel M: Cardiopulmonary bypass, rewarming and central nervous system dysfunction. Ann Thorac Surg 61:1423-7, 1996.

*6. Cheng W, Hartmann JF, Cameron DE, Griffiths EM, Kirsch JR, Traystman RJ: Cerebral blood flow during cardiopulmonary bypass: influence of temperature and pH management strategy. Ann Thorac Surg 59:880-6, 1995.

7. Cook DJ, Orszulak TA, Daly RC, Buda DA: Cerebral hyperthermia during cardiopulmonary bypass in adults. J Thorac Cardiovasc Surg 111:268-9, 1996.

8. Cook DJ, Proper JA, Orszulak TA, Daly RC, Oliver WC Jr: Effect of pump flow rate on cerebral blood flow during hypothermic cardiopulmonary bypass in adults. J Cardiothorac Vasc Anesth 11:415-9, 1997.

9. Cook DJ, Plochl W, Orszulak TA: Effect of temperature and PaCO2 on cerebral embolization during cardiopulmonary bypass in swine. Ann Thorac Surg  69(2):415-20, 2000.

*10. Croughwell ND, Reves JG, White WD, Grocott HP, Baldwin BI, Clements FM, Davis RD Jr, Jones RH, Newman MF: Cardiopulmonary bypass time does not affect cerebral blood flow. Ann Thorac Surg 65:1226-30, 1998.

*11. Croughwell ND, White WD, Smith LR, Davis RD, Blower DD Jr, Reves JG, Newman MF: Jugular bulb saturation and mixed venous saturation during cardiopulmonary bypass. J Card Surg 10(4 Suppl):503-8, 1995.

*12. Dexter F, Kern FH, Hindman BJ, Greeley WJ: The brain uses mostly dissolved oxygen during profoundly hypothermic cardiopulmonry bypass. Ann Thorac Surg 63:1725-1729, 1997.

13. Edmonds HL Jr, Griffiths LK, van der Laken J, Slater AD, Shields CB: Quantitative electroencephalographic monitoring during myocardial revascularization predicts postoperative disorientation and improves outcome. J Thorac Cardiovasc Surg 103:555-63, 1992.

14. Ederberg S, Westerlind A, Houltz E, Svensson SE, Elam M, Ricksten SE: The effects of propofol on cerebral blood flow velocity and cerebral oxygen extraction during cardiopulmonary bypass. Anesth Analg 86:1201-6, 1998.

*15. Engelman RM, Pleet AB, Rousou JA, Flack JER, Deaton DW, Kulshrestha P, Gregory CA, Pekow PS: Does cardiopulmonary bypass temperature correlate with postoperative central nervous system dysfunction? J Card Surg 10(4 Suppl):493-7, 1995.

*16. Enomoto S, Hindman BJ, Dexter F, Smith T, Cutkomp J: Rapid rewarming causes an increase in the cerebral metabolic rate for oxygen that is temporarily unmatched by cerebral blood flow. Anesthesiology 84:1392-1400, 1996.

17. Feerick AE, Johnston WE, Jenkins LW, Lin CY, Mackay JH, Prough DS: Hyperglycemia during hypothermic canine cardiopulmonary bypass increases cerebral lactate. Anethesiology 82:512-20, 1995.

18. Ghariani S, Liard L, Spaey J, Noirhomme PH, El Koury GA, de Tourtchaninoff M, Dion RA, Guerit JM: Retrospective study of somatosensory evoked potential monitoring in deep hypothermic circulatory arrest. Ann Thorac Surg 67:1915-8, 1999.

*19. Gold JP, Charlson ME, Williams-Russo P, Szatrowski TP, Peterson JC, Pirraglia PA, Hartman GS, Yao FSF, Hollenberg JP, Barbut D, Hayes JG, Thomas SJ, Purcell MH, Mattis S, Gorkin L, Post M, Krieger KH, Isom OW: Improvement of outcomes after coronary artery bypass: a randomized trial comparing intraoperative high versus low mean arterial pressure. J Thorac Cardiovasc Surg 110:1302-11, 1995.

20. Gravlee GP, Roy RC, Stump DA, Hudspeth AS, Rogers AT, Prough DS: Regional cerebrovascular reactivity to carbon dioxide during cardiopulmonary bypass in patients with cerebrovascular disease. J Thorac Cardiovasc Surg 99:1022-9, 1990.

21. Hanel F, von Knobelsdorff G, Werner C, Schulte am Esch J: Hypercapnia prevents jugular bulb desaturation during rewarming from hypothermic cardiopulmonary bypass. Anesthesiology 89:19-23, 1998.

22. Henriksen L: Brain luxury perfusion during cardiopulmonary bypass in humans. A study of the cerebral blood flow response to changes in CO2, O2, and blood pressure. J Cereb Blood Flow Metab 6:366-78, 1986.

23. Hindman BJ, Dexter F, Cutkomp J, Smith T, Todd MM, Tinker JH: Brain blood flow and metabolism do not decrease at stable brain temperature during cardiopulmonary bypass in rabbits. Anesthesiology 77:342-50, 1993.

24. Hindman BJ, Dexter F, Cutkomp J, Smith T, Tinker JH: Hypothermic acid-base management does not affect cerebral metabolic rate for oxygen at 27-C. A study during cardiopulmonary bypass in rabbits. Anesthesiology 79:580-7, 1993.

*25. Hindman BJ, Dexter F, Ryu KH, Smith T, Cutkomp J: Pulsatile versus nonpulsatile cardiopulmonary bypass: no difference in brain blood flow or metabolism at 27-C. Anesthesiology 80:1137-47, 1994.

*26. Hindman BJ, Dexter F, Cutkomp J, Smith T: pH-stat management reduces the cerebral metabolic rate for oxygen during profound hypothermia (17-C). A study during cardiopulmonary bypass in rabbits. Anesthesiology 82:983-95, 1995.

*27. Hindman BJ, Dexter F, Smith T, Cutkomp J: Pulsatile versus nonpulsatile flow. No difference in cerebral blood flow or metabolism during normothermic cardiopulmonary bypass in rabbits. Anesthesiology 82:241-50, 1995.

28. Ip-Yam PC, Thomas SD, Jackson M, Rashid A, Behl S: Effects of temperature strategy during cardiopulmonary bypass on cerebral oxygen balance. J Cardiovasc Surg (Torino) 41(1):1-6, 2000.

*29. Johnston WE, DeWitt DS, Vinten-Johansen J, Stump DA, Prough DS: Phenylephrine does not reduce cerebral perfusion during canine cardiopulmonary bypass. Anesth Analg 79:14-18, 1994.

30. Kadoi Y, Kawahara F, Saito S, Morita T, Kunimoto F, Goto F, Fujita N: Effects of hypothermic and normothermic cardiopulmonary bypass on brain oxygenation. Ann Thorac Surg 68:34-9, 1999.

31. Kawahara F, Kadoi Y, Saito S, Yoshikawa D, Goto F, Fujita N: Balloon pump-induced pulsatile perfusion during cardiopulmonary bypass does not improve brain oxygenation. J Thorac Cardiovasc Surg 118:361-6, 1999.

32. Kim WG, Lim C, Moon HJ, Kim YJ: Comparative analysis of alpha-stat and pH-stat strategies with a membrane oxygenator during deep hypothermic circulatory arrest in young pigs. Artif Organs 24(11):908-12, 2000.

33. Lanier WL: Glucose management during cardiopulmonary bypass: cardiovascular and neurologic implications. Anesth Analg 72:423-7, 1991.

34. Levy WJ: Quantitative analysis of EEG changes during hypothermia. Anesthesiology 60:291-7, 1984.

*35. Martin TD, Craver JM, Gott JP, Weintraub WS, Ramsay J, Mora CT, Guyton RA: Prospective, randomized trial of retrograde warm blood cardioplegia: myocardial benefit and neurologic threat. Ann Thorac Surg 57:298-304, 1994.

36. McCullough JN, Zhang N, Reich DL, Juvonen TS, Klein JJ, Spielvogel D, Ergin MA, Griepp, RB: Cerebral metabolic suppression during hypothermic circulatory arrest in humans. Ann Thorac Surg 67:1895-9, 1999.

37. Michenfelder JD, Milde JH: The effect of profound levels of hypothermia (below 14(C) on canine cerebral metabolism. J Cereb Blood Flow Metab 12:877-80, 1992.

*38. Michenfelder JD, Milde JH: The relationship among canine brain temperature, metabolism, and function during hypothermia. Anesthesiology 75:130-6, 1991.

*39. Michler RE, Sandhu AA, Young WL, Schwartz AE: Low-flow cardiopulmonary bypass: importance of blood pressure in maintaining cerebral blood flow. Ann Thorac Surg 60(6 Suppl):S525-8, 1995.

* 40. Miyano H, Inagaki M, Hashimoto N. Shishido T, Kawada T, Miyake Y, Sunagawa K: Regional cerebral blood flow during rewarming of cardiopulmonary bypass correlates with posthypothermic regional glucose use. J Thorac Cardiovasc Surg 116:503-10, 1998.

*41. Mora CT, Henson MB, Weintraub WS, Murkin JM, Martin TD, Craver JM, Gott JP, Guyton RA: The effect of temperature management during cardiopulmonary bypass on neurologic and neuropsychologic outcomes in patients undergoing coronary revascularization. J Thorac Cardiovasc Surg 112:514-22, 1996.

+42. Murkin JM, Farrar JK, Tweed WA, McKenzie FN, Guiraudon G: Cerebral autoregulation and flow/metabolism coupling during cardiopulmonary bypass: the influence of PaCO2. Anesth Analg 66:825-832, 1987.

*43. Murkin JM: Hypothermic cardiopulmonary bypass-time for a more temperate approach. Can J Anaesth 42:663-8, 1995.

*44. Murkin JM, Martzke JS, Buchan AM, Bentley C, Wong CJ: A randomized study of the influence of perfusion technique and pH management in 316 patients undergoing coronary artery bypass surgery. J Thorac Cardiovasc Surg 110:349-162, 1995.

*45. Mutch WA, Sutton IR, Teskey JM, Cheang MS, Thomson IR: Cerebral pressure-flow relationship during cardiopulmonary bypass in the dog at normothermia and moderate hypothermia. J Cereb Blood Flow Metab 14:510-8, 1994.

46. Nara M, Chiba Y, Niwa H, Kimura T, Ihaya A, Morioka K, Uesaka T, Tsuda T, Muraoka R: Experimental determination of the safe minimum perfusion flow rate for low-flow hypothermic cardiopulmonary bypass. Cardiovasc Surg 7:715-22, 1999.

*47. Nathan HJ, Lavallee G: The management of temperature during hypothermic cardiopulmonary bypass: I-Canadian survey. Can J Anaesth 42:669-71, 1995.

*48. Newman MF, Croughwell ND, White WD, Lowry E, Baldwin BI, Clements FM, Davis RD Jr, Jones RH, Amory DW, Reves JG: Effect of perfusion pressure on cerebral blood flow during normothermic cardiopulmonary bypass. Circulation 94(9 Suppl):II353-7, 1996.

*49. Newman MF, Croughwell ND, White WD, Sanderson I, Spillane W, Reves JG: Pharmacologic electroencephalographic suppression during cardiopulmonary bypass: a comparison of thiopental and isoflurane. Anesth Analg 86:246-51, 1998.

50. Nollert G, Mohnle P, Tassani-Prell P, Reichart B: Determinants of cerebral oxygenation during cardiac surgery. Circulation 92(9 Suppl):II327-3, 1995.

51. Okano N. Owada R, Fujita N, Kadoi Y, Saito S, Goto F: Cerebral oxygenation is better during mild hypothermic than normothermic cardiopulmonary bypass. Can J Anaesth 47(2):131-6, 2000.

*52. Patel RL, Turtle MR, Chambers DJ, James DN, Newman S, Venn GE: Alpha-stat acid-base regulation during cardiopulmonary bypass improves neuropsychologic outcome in patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 111:1267-79, 1996.

53. Philpott JM, Eskew TD, Sun YS, Dennis KJ, Foreman BH, Fairbrother SN, Brown PM Jr, Koutlas TC, Chitwood WR Jr, Lust RM: A paradox of cerebral hyperperfusion in the face of cerebral hypotension: the effect of perfusion pressure on cerebral blood flow and metabolism during normothermic cardiopulmonary bypass. J Surg Res 77:141-9, 1998.

*54. Plochl W, Cook DJ: Quantification and distribution of cerebral emboli during cardiopulmonary bypass in the swine: the impact of PaCO2. Anesthesiology 90:183-90, 1999.

55. Plochl W, Cook DJ, Orszulak TA, Daly RC: Critical cerebral perfusion pressure during tepid heart operations in dogs. Ann Thorac Surg 66:118-24, 1998.

56. Plochl W, Cook DJ, Orszulak TA, Daly RC: Intracranial pressure and venous cannulation for cardiopulmonary bypass. Anesth Analg 88:329-31, 1999.

57. Priestley MA, Golden JA, O’Hara IB, McCann J, Kurth CD: Comparison of neurologic outcome after deep hypothermic circulatory arrest with alpha-stat and pH-stat cardiopulmonary bypass in newborn pigs.
J Thorac Cardiovasc Surg 121(2):336-43, 2001.

58. Prough DS, Rogers AT: What are the normal levels of cerebral blood flow and cerebral oxygen consumption during cardiopulmonary bypass in humans? Anesth Analg 76:690-693, 1993.

59. Prough DS, Rogers AT, Stump DA, Roy RC, Cordell AR, Phipps J, Taylor CL: Cerebral blood flow decreases with time whereas cerebral oxygen consumption remains stable during hypothermic cardiopulmonary bypass in humans. Anesth Analg 72:161-168, 1991.

60. Prough DS, Rogers AT, Stump DA, Mills SA, Gravlee GP, Taylor C: Hypercarbia depresses cerebral oxygen consumption during cardiopulmonary bypass. Stroke 21:1162-1166, 1990.

61. Regragui I, Birdi I, Izzat MB, Black AM, Lopatatzidis A, Day CJ, Gardner F, Bryan AJ, Angelini GD: The effects of cardiopulmonary bypass temperature on neuropsychologic outcome after coronary artery operations: a prospective randomized trial. J Thorac Cardiovasc Surg. 112:1036-1045, 1996

62. Rodriguez RA, Edmonds HL, Auden SM, Austin EH 3rd: Auditory brainstem evoked responses and temperature monitoring during pediatric cardiopulmonary bypass. Can J Anaesth 46:832-9, 1999.

*63. Rogers AT, Prough DS, Roy RC, Gravlee GP, Stump DA, Cordell AR, Phipps J, Taylor CL: Cerebrovascular and cerebral metabolic effects of alterations in perfusion flow rate during hypothermic cardiopulmonary bypass in man. J Thorac Cardiovasc Surg 103:363-368, 1992.

64. Schwartz AE, Sandhu AA, Kaplon RJ, Young WL, Jonassen AE, Adams DC, Edwards NM, Sistino JJ, Kwiatkowski P, Michler RE: Cerebral blood flow is determined by arterial pressure and not cardiopulmonary bypass flow rate. Ann Thorac Surg 60:165-169, 1995.

*65. Shin’oka, T, Shum-Tim, D, Laussen PC, Zinkovsky SM, Lidov HG, du Plessis A, Jonas RA: Effects of oncotic pressure and hematocrit on outcome after hypothermic circulatory arrest. Ann Thorac Surg 65:155-64, 1998.

+66. Slogoff S, Reul GJ, Keats AS, Curry GR, Crum ME, Elmquist BA, Giesecke NM, Jistel JR, Rogers LK, Soderberg JD, Edelman SK: Role of perfusion pressure and flow in major organ dysfunction after cardiopulmonary bypass. Ann Thorac Surg 50:911-918, 1990.

*67. Stephan H, Weyland A, Kazmaier S, Henze T, Menck S, Sonntag H: Acid-base management during hypothermic cardiopulmonary bypass does not affect cerebral metabolism but does affect blood flow and neurological outcome. Br J Anaesth 69:51-57, 1992.

*68. Stone JG, Young WL, Smith CR, Solomon RA, Wald A, Ostapkovich N, Shrebnick DB: Do standard monitoring sites reflect true brain temperature when profound hypothermia is rapidly induced and reversed? Anesthesiology 82:344-351, 1995.

69. Sungurtekin H, Boston US, Cook DJ: Bypass flow, mean arterial pressure, and cerebral perfusion during cardiopulmonary bypass in dogs. J Cardiothorac Vasc Anesth 14(1):25-8, 2000. 

70. Sungurtekin H, Cook DJ, Orszulak TA, Daly RC, Mullany CJ: Cerebral response to hemodilution during hypothermic cardiopulmonary bypass in adults. Anesth Analg 89:1078-83, 1999.

71. Swain JA, McDonald TJ Jr, Robbins RC, Balaban RS: Relationship of cerebral and myocardial intracellular pH to blood pH during hypothermia. Am J Physiol 260:H1640-H1644, 1991

72. Testolin L, Roques X, Laborde MN, Roques F, Mukai S, Baudet E: Moderately hypothermic cardiopulmonary bypass and selective cerebral perfusion in ascending aorta and aortic arch surgery. Preliminary experience in twenty-two patients. Cardiovasc Surg 6:398-405, 1998.

73. Tranmer BI, Gross CE, Kindt GW, Adey GR: Pulsatile versus nonpulsatile blood flow in the treatment of acute cerebral ischemia. Neurosurgery 19:724-731, 1986.

74. von Knobelsdorff G, Hanel F, Werner C, Schulte am Esch J: Jugular bulb oxygen saturation and middle cerebral blood flow velocity during cardiopulmonary bypass. J Neurosurg Anesthesiol 9:128-133, 1997.

+75. The Warm Heart Investigators: Randomized trial of normothermic versus hypothermic coronary bypass surgery. Lancet 343:559-563, 1994.

*76. Wass CT, Cable DG, Schaff HV, Lanier WL: Anesthetic technique influences brain temperature during cardiopulmonary bypass in dogs. Ann Thorac Surg 65:454-60, 1998.

77. Wass CT, Waggoner JR 3rd, Cable DG, Schaff HV, Schroeder DR, Lanier WL: Selective convective brain cooling during hypothermic cardiopulmonary bypass in dogs. Ann Thorac Surg 66:2008-14, 1998.

*78. Watanabe T, Orita H, Kobayashi M, Washio M: Brain Tissue pH, oxygen tension, and carbon dioxide tension in profoundly hypothermic cardiopulmonary bypass. Comparative study of circulatory arrest, nonpulsatile low-flow perfusion, and pulsatile low-flow perfusion. J Thorac Cardiovasc Sug 97:396-401, 1989.

79. Watanabe T, Oshikiri N, Inui K, Kuraoka S, Minowa T, Hosaka J, Takahashi T, Shimazaki Y: Optimal blood flow for cooled brain at 20 C. Ann Thorac Surg 68:864-9, 1999.

Pathophysiology

  • Emboli
  • Markers of ischemia
  • Risk factors and testing
  • Cerebral protection
  • Monitors of pathophysiologic effects

1. Ali MS, Harmer M, Vaughan R: Serum S100 protein as a marker of cerebral damage during cardiac surgery. Br J Anaesth 85(2):287-98, 2000.

2. Anderson RE, Hansson LO, Liska J, Settergren G, Vaage J: The effect of cardiotomy suction on the brain injury marker S100beta after cardiopulmonary bypass. Ann Thorac Surg 69(3):847-50, 2000 .

3. Anderson RE, Hansson LO, Nilsson O, Liska J. Settergren G, Vaage J: Increase in serum S100A1-B and S100BB during cardiac surgery arises from extracerebral sources. Ann Thorac Surg 71(5):1512-7, 2001.

4. Anderson RV, Siegman MG, Balaban RS, Ceckler TL, Swain JA: Hyperglycemia increases cerebral intracellular acidosis during circulatory arrest. Ann Thorac Surg 54:1126-30, 1992.

5. Anttila V, Rimpilainen J, Pokela M, Kiviluoma K, Makiranta M, Jantti V, Vainionpaa V, Hirvonen J, Jovonen T: Lamotrigine improves cerebral outcome after hypothermic circulatory arrest: a study in a chronic porcine model. J Thorac Cardiovasc Surg 120(2):247-55, 2000 .

6. Baird DL, Murkin JM, Lee DL: Neurologic findings in coronary artery bypass patients: perioperative or pre-existing? J Cardiothorac Vasc Anesth 11:694-8, 1997.

7. Baumgartner WA, Redmond JM, Zehr KJ, Brock MV, Tseng EE, Blue ME, Troncoso JC, Johnston MV: The role of monosialoganglioside, GM1 as a neuroprotectant in an experimental model of cardiopulmonary bypass and hypothermic circulatory arrest. Ann N Y Acad Sci 845:382-90, 1998.

8. Baumgartner WA, Walinsky PL, Salazar JD, Tseng EE, Brock MV, Doty JR, Redmond JM, Blue ME, Goldsborough MA, Troncoso JC, Johnston MV: Assessing the impact of cerebral injury after cardiac surgery: will determining the mechanism reduce this injury? Ann Thorac Surg 67:1871-3, 1999.

9. Bokesch PM, Kapural M, Drummond-Webb J, Baird K, Kapural L, Mee RB, Trapp B, Starr NJ: Neuroprotective, anesthetic, and cardiovascular effects of the NMDA antagonist, CNS 5161A, in isoflurane-anesthetized lambs. Anesthesiology 93(1):202-8, 2000.

10. Bokesch PM, Marchand J, Seirafi PA, Deiss JM, Warner KG, Bronson RT, Kream RM: Immediate-early gene expression in ovine brain after cardiopulmonary bypass and hypothermic circulatory arrest. Anesthesiology 85:1439-46, 1996.

11. Bokesch PM, Seirafi PA, Warner KG, Marchand JE, Kream RM, Trapp B: Differential immediate-early gene expression in ovine brain after cardiopulmonary bypass and hypothermic circulatory arrest. Anesthesiology 89:961-8, 1998.

*12. Brain damage after open-heart surgery. Lancet 1:1161-3, 1982.

13. Brown WR, Moody DM, Challa VR, Stump DA, Hammon JW: Longer duration of cardiopulmonary bypass is associated with greater numbers of cerebral microemboli. Stroke 31(3):707-13, 2000 .

14. Brown WR, Moody DM, Stump DA, Deal DD, Anderson RL: Dog model for cerebrovascular studies of the proximal-to-distal distribution of sequentially injected emboli. Microvasc Res 50:105-12, 1995.

15. Challa VR, Lovell MA, Moody DM, Brown WR, Reboussin DM, Markesbery WR: Laser microprobe mass spectrometric study of aluminum and silicon in brain emboli related to cardiac surgery. J Neuropath Exp Neurol 57:140-7, 1998.

*16. Conroy BP, Lin CY, Jenkins LW, DeWitt DS, Zornow MH, Uchida T, Johnston WE: Hypothermic modulation of cerebral ischemic injury during cardiopulmonary bypass in pigs. Anesthesiology 88:390-402, 1998.

*17. Cook DJ, Anderson RE, Michenfelder JD, Oliver WC Jr, Orszulak TA, Daly RC, Bryce RD: Cerebral blood flow during cardiac operations: comparison of Kety-Schmidt and xenon-133 clearance methods. Ann Thorac Surg 59:614-20, 1995.

*18. Croughwell ND, Newman MF, Blumenthal JA, White WD, Lewis JB, Frasco PE, Smith LR, Thyrum EA, Hurwitz BJ, Leone BJ, Schell RM, Reves JG: Jugular bulb saturation and cognitive dysfunction after cardiopulmonary bypass. Ann Thorac Surg 58:1702-8, 1994.

*19. Croughwell N, Lyth M, Quill TJ, Newman M, Greeley WJ, Smith LR, Reves JG: Diabetic patients have abnormal cerebral autoregulation during cardiopulmonary bypass. Circulation 82(5 Suppl):IV407-IV412, 1990.

20. Daubeney PE, Pilkington SN, Janke E, Charlton GA, Smith DC, Webber SA: Cerebral oxygenation measured by near-infrared spectroscopy: comparison with jugular bulb oximetry. Ann Thorac Surg 61:930-4, 1996.

21. DeBlasi RA, Almenrader N, Ferrari M: Brain oxygenation monitoring during cardiopulmonary bypass by near infrared spectroscopy. Adv Exp Med Biol 413:97-104, 1997.

22. Degirmenci B, Durak H, Hazan E, Karabay O, Derebek E, Yilmaz M, Ozbilek E, Oto O: The effect of coronary artery bypass surgery on brain perfusion. J Nucl Med 39:587-91, 1998.

23. Derkach DN, Okamoto H, Takahashi S: Neuronal and astroglial injuries in patients undergoing coronary artery bypass grafting and aortic arch replacement during hypothermic cardiopulmonary bypass. Anesth Analg 91(5):1066-72, 2000.

24. Dewanjee MK, Wu SM, Burke GW 3rd, Hsu, LC: Tumor necrosis factor-alpha in plasma during cardiopulmonary bypass in a pig model: correlation with marginated neutrophils and cerebral edema by magnetic resonance imaging. ASAIO J 44:212-18, 1998.

25. Dexter F, Hindman BJ, Marshall JS: Estimate of the maximum absorption rate of microscopic arterial air emboli after entry into the arterial circulation during cardiac surgery. Perfusion 11:445-50, 1996.

*26. Ergin MA, Uysal S, Reich DL, Apaydin A, Lansman SL, McCollough JN, Griepp RB: Temporary neurological dysfunction after deep hypothermic circulatory arrest: A clinical marker of long-term functional deficit. Ann Thorac Surg 67:1887-90, 1999.

27. Filgueiras CL, Ryner L, Ye J, Yang L, Ede M, Sun J, Kozlowski P, Summers R, Saunders JK, Salerno TA, Deslauriers R: Cerebral protection during moderate hypothermic circulatory arrest: histopathology and magnetic resonance spectroscopy of brain energetics and intracellular pH in pigs. J Thorac Cardiovasc Surg 112:1073-80, 1996.

28. Gillinov AM, Redmond JM, Zehr KJ, Troncoso JC, Arroyo S, Lesser RP, Lee AW, Stuart RS, Reitz BA, Baumgartner WA, Cameron DE: Superior cerebral protection with profound hypothermia during circulatory arrest. Ann Thorac Surg 55:1432-9, 1993.

29.  Goldstein LJ, Davies RR, Rizzo JA, Davila JJ, Cooperberg MR, Shaw RK, Kopf GS, Elefteriades JA: Stroke in surgery of the thoracic aorta: incidence, impact, etiology, and prevention. J Thorac Cardiovasc Surg 122(5):935-45, 2001.

30. Goto T, Yoshitake A, Baba T, Shibata Y, Sakata R, Uozumi H: Cerebral ischemic disorders and cerebral oxygen balance during cardiopulmonary bypass surgery: preoperative evaluation using magnetic resonance imaging and angiography. Anesth Analg 84:5-11, 1997.

31. Gray AT, Buck LT, Feiner JR, Bickler PE: Interactive effects of pH and temperature on N-methyl-D-aspartate receptor activity in rat cortical brain slices. J Neurosurg Anesthesiol 9:180-7, 1997.

32. Hagl C, Tatton NA, Weisz DJ, Zhang N, Spielvogel D, Shiang HH, Bodian CA, Griepp RB: Cyclosporine A as a potential neuroprotective agent: a study of prolonged hypothermic circulatory arrest in a chronic porcine model. Eur J Cardiothorac Surg 19(6):756-64, 2001.

33. Hall RA, Fordyce DJ, Lee ME, Eisenberg B, Lee RF, Holmes JH, Campbell, WG: Brain SPECT imaging and neuropsychological testing in coronary artery bypass patients: single photon emission computed tomography. Ann Thorac Surg 68:2082-8, 1999.

34. Hermann M, Ebert AD, Galazky I, Wunderlich MT, Kunz WS, Huth C: Neurobehavioral outcome prediction after cardiac surgery: role of neurobiochemical markers of damage to neuronal and glial brain tissue. Stroke 31(3):645-50, 2000.

35. Hett DA, Smith DC, Pilkington SN, Abbott TR: Effect of temperature and cardiopulmonary bypass on the auditory evoked response. Br J Anaesth 75:293-6, 1995.

*36. Hindman BJ, Funatsu N, Cheng DC, Bolles R, Todd MM, Tinker JH: Differential effect of oncotic pressure on cerebral and extracerebral water content during cardiopulmonary bypass in rabbits. Anesthesiology 73:951-7, 1990.

37. Hindman BJ, Moore SA, Cutkomp J, Smith T, Ross-Barta SE, Dexter F, Brian JE Jr: Brain expression of inducible cyclooxygenase 2 messenger RNA in rats undergoing cardiopulmonary bypass. Anesthesiology 95(6):1380-8, 2001.

38. Inoue S, Hayashi Y, Ohnishi Y, Kikumoto K, Minamino N, Kangawa K, Matsuo H, Furuya H, Kuro M: Cerebral production of adrenomedullin after hypothermic cardiopulmonary bypass in adult cardiac surgical patients. Anesth Analg 88:1030-5, 1999.

*39. Johnston WE, Jenkins LW, Lin CY, DeWitt DS, Feerick AE, Deyo DJ, Prough DS: Cerebral metabolic consequences of hypotensive challenges in hemodiluted pigs with and without cardiopulmonary bypass. Anesth Analg 81:911-8, 1995.

40. Johnston WE, Stump DA, DeWitt DS, Vinten-Johansen J, O'Steen WK, James RL, Prough DS: Significance of gaseous microemboli in the cerebral circulation during cardiopulmonary bypass in dogs. Circulation 88:II319-29, 1993.

41. Kincaid EH, Jones TJ, Stump DA, Brown WR, Moody DM, Deal DD, Hammon JW Jr: Processing scavenged blood with a cell saver reduces cerebral lipid microembolization. Ann Thorac Surg 70(4):1296-300, 2000.

42. Kouchoukos NT: Adjuncts to reduce the incidence of embolic brain injury during operations on the aortic arch. Ann Thorac Surg 57:243-5, 1994.

43. Kurth CD, Priestley M, Watzman HM, McCann J, Golden J: Desflurane confers neurologic protection for deep hypothermic circulatory arrest in newborn pigs. Anesthesiology 95(4):959-64, 2001.

44. Langley SM, Chai PJ, Jaggers JJ, Ungerleider RM: Preoperative high dose methylprednisolone attenuates the cerebral response to deep hypothermic circulatory arrest. Eur J Cardiothorac Surg 17(3):279-86, 2000.

45. Laursen H, Waaben J, Gefke K, Husum B, Andersen LI, Sorensen HR: Brain histology, blood-brain barrier and brain water after normothermic and hypothermic cardiopulmonary bypass in pigs. Eur J Cardiothorac Surg 3:539-43, 1989.

46. LeMaire SA, Bhama JK, Schmittling ZC, Oberwalder PJ, Koksoy C, Raskin SA, Curling PE, Coselli JS: S100beta correlates with neurologic complications after aortic operation using circulatory arrest. Ann Thorac Surg 71(6):1913-8; discussion 1918-9, 2001.

47. Lloyd CT, Ascione R, Underwood MJ, Gardner F, Black A, Angelini GD: Serum S-100 protein release and neuropsychologic outcome during coronary revascularization on the beating heart: a prospective randomized study. J Thorac Cardiovasc Surg 119(1):148-54, 2000.

48. MacVeigh I, Cook DJ, Orszulak TA, Daly RC, Munnikhuysen DE: Nitrous oxide method of measuring cerebral blood flow during hypothermic cardiopulmonary bypass. Ann Thorac Surg 63:736-40, 1997.

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50. Marochnik S, Alexandrov AV, Anthone D, Lewin C, Caldwell CB, Pullicino PM: Feasibility of SPECT for studies of brain perfusion during cardiopulmonary bypass. J Neuroimaging 6:243-5, 1996.

51 Mathew JP, Weatherwax KJ, East CJ, White WD, Reves JG: Bispectral analysis during cardiopulmonary bypass: the effect of hypothermia on the hypnotic state. J Clin Anesth 13(4):301-5, 2001.

52. Mault JR, Ohtake S, Klingensmith ME, Heinle JS, Greeley WJ, Ungerleider RM: Cerebral metabolism and circulatory arrest: effects of duration and strategies for protection. Ann Thorac Surg 55:57-63, 1993.

53. McKhann GM, Goldsborough MA, Borowicz LM Jr, Mellits ED, Brookmeyer R, Quaskey SA, Baumgartner WA, Cameron DE, Stuart RS, Gardner TJ: Predictors of stroke risk in coronary artery bypass patients. Ann Thorac Surg 63:516-21, 1997.

*54. Metz S, Slogoff S: Thiopental sodium by single bolus dose compared to infusion for cerebral protection during cardiopulmonary bypass. J Clin Anesth 2:226-31, 1990.

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56. Neville MJ, Butterworth J, James RL, Hammon JW, Stump DA: Similar neurobehavioral outcome after valve or coronary artery operations despite differing carotid embolic counts. J Thorac Cardiovasc Surg 121(1):125-36, 2001.

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61. Orihashi K, Matsuura Y, Sueda T, Shikata H, Watari M, Okada K: Clinical implication of orbital ultrasound monitoring during selective cerebral perfusion.
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62. Redmond JM, Greene PS, Goldsborough MA, Cameron DE, Stuart RS, Sussman MS, Watkins L Jr, Laschinger JC, McKhann GM, Johnston MV, Baumgartner WA: Neurologic injury in cardiac surgical patients with a history of stroke. Ann Thorac Surg 61:42-7, 1996.

63. Sakurada T, Kazui T, Tanaka H, Komatsu S: Comparative experimental study of cerebral protection during aortic arch reconstruction. Ann Thorac Surg 61:1348-54, 1996.

64. Salazar JD, Wityk RJ, Grega MA, Borowicz LM, Doty JR, Petrofski JA, Baumgartner WA: Stroke after cardiac surgery: short- and long-term outcomes. Ann Thorac Surg 72(4):1195-201; discussion 1201-2, 2001.

65. Scheller MS: Routine barbiturate brain protection during cardiopulmonary bypass cannot be recommended. J Neurosurg Anesthesiol 4:60-3, 1992.

66. Schmidlin D, Hager P, Schmid ER: Monitoring level of sedation with bispectral EEG analysis: comparison between hypothermic and normothermic cardiopulmonary bypass. Br J Anaesth 86(6):769-76, 2001.

67. Schonburg M, Urbanek P, Erhardt G, Kraus B, Taborski U, Muhling A, Hein S, Roth M, Tiedtke HJ, Klovekorn WP: Significant reduction of air microbubbles with the dynamic bubble trap during cardiopulmonary bypass. Perfusion 16(1):19-25, 2001.

68. Schwender D, Kaiser A, Klasing S, Peter K, Poppel E: Midlatency auditory evoked potentials and explicit and implicit memory in patients undergoing cardiac surgery. Anesthesiology 80:493-501, 1994.

69. Shaaban Ali M, Harmer M, Vaughan RS, Dunne J, Latto IP: Early release pattern of S100 protein as a marker of brain damage after warm cardiopulmonary bypass. Anaesthesia 55(8):802-6, 2000.

70. Shake JG, Peck EA, Marban E, Gott VL, Johnston MV, Troncoso JC, Redmond JM, Baumgartner WA: Pharmacologically induced preconditioning with diazoxide: a novel approach to brain protection. Ann Thorac Surg 72(6):1849-54, 2001.

71. Smith MH, Wagenknecht LE, Legault C, Goff DC, Stump DA, Troost BT, Rogers AT: Age and other risk factors for neuropsychologic decline in patients undergoing coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 14(4):428-32, 2000.

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73. Steinberg GK, De La Paz R, Mitchell RS, Bell TE, Albers GW: MR and cerebrospinal fluid enzymes as sensitive indicators of subclinical cerebral injury after open-heart valve replacement surgery. Am J Neuroradiol 17:205-12, 1996.

74. Stump DA, James RL, Murkin JM: Is that outcome different or not? The effect of experimental design and statistics on neurobehavioral outcome studies. Ann Thorac Surg 70(5):1782-5, 2000.

75. Tofukuji M, Metais C, Collard CD, Morse DS, Stahl GL, Nelson DP, Li J, Simons M, Selke FW: Effect of sialyl Lewis (x) oligosaccharide on myocardial and cerebral injury in the pig. Ann Thorac Surg 67:112-9, 1999.

76. Toner I, Taylor KM, Lockwood G, Newman S, Smith PL: EEG changes during cardiopulmonary bypass surgery and postoperative neuropsychological deficit: the effect of bubble and membrane oxygenators. Eur J Cardiothorac Surg 11:312-9, 1997.

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78. Tuman KJ, McCarthy RJ, Najafi H, Ivankovich AD: Differential effect of advanced age on neurologic and cardiac risks of coronary artery operations. J Thorac Cardiovasc Surg 104:1510-7, 1992.

79. Vingerhoets G, Van Nooten G, Vermassen F, DeSoete G, Jannes C: Short-term and long-term neuropsychological consequences of cardiac surgery with extracorporeal circulation. Eur J Cardiothorac Surg 11:424-31, 1997.

80. Westaby S, Johnsson P, Parry AJ, Blomqvist S, Solem JO, Alling C, Pillai R, Taggart DP, Grebenik C, Stahl E: Serum S100 protein: a potential marker for cerebral events during cardiopulmonary bypass. Ann Thorac Surg 61:88-92, 1996.

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82. Yerlioglu ME, Wolfe D, Mezrow CK, Weisz DJ, Midulla PS, Zhang N, Shiang HH, Bodian C, Griepp RB: The effect of retrograde cerebral perfusion after embolization to the brain. J Thorac Cardiovasc Surg 110:1470-84, 1995.

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Other

  • Perfluorocarbons
  • Hemoglobin substitutes and CPB/Brain
  • Cerebroplegia

*1. Aoki M, Jonas RA, Nomura F, Stromski ME, Tsuji MK, Hickey PR, Holtzman D: Effects of cerebroplegic solutions during hypothermic circulatory arrest and short-term recovery. J Thorac Cardiovasc Surg 108:291-301, 1994.

*2. Bachet J, Guilmet D, Goudot B, Termignon JL, Teodori G, Dreyfus G, Brodaty D, Dubois C, Delentdecker P: Cold cerebroplegia. J Thorac Cardiovasc Surg 102:85-93, 1991.

3. Briceno JC, Rincon IE, Velez JF Castro I, Arcos MI, Velasquez CE: Oxygen transport and consumption during experimental cardiopulmonary bypass using oxyfluor. ASAIO J 45:322-7, 1999.

4. Briceno JC, Runge TM, McGinity JW, Frisbee SE, Ottmers SE, Korvick DL, Calhoon JH, Miller OL, Hantler CB, Cruzen OG, Ybarra JR, Howelton RV, Mireles RZ, Benson CK: Changes in brain pH, PO2, PCO2, cerebral blood flow, and blood gases induced by a hyperosmolar oxyreplete hemosubstitute during cardiopulmonary bypass. ASAIO J 43:13-18, 1997.

5. Cannon ML, Cheifetz IM, Craig DM, Hubble CL, Quick G, Ungerleider RM, Smith PK, Meliones JN: Optimizing liquid ventilation as a lung protection strategy for neonatal cardiopulmonary bypass: full functional residual capacity dosing is more effective than half functional residual capacity dosing. Crit Care Med 27:1052-3, 1999.

*6. Cochran RP, Kunzelman KS, Vocelka CR, Akimoto H, Thomas R, Soltow LO, Spiess BD: Perfluorocarbon emulsion in the cardiopulmonary bypass prime reduces neurologic injury. Ann Thorac Surg 63:1326-1332, 1997.

7. Forbess JM, Ibla JC, Lidov HG, Cioffi MA, Hiramatsu T, Laussen P, Miura T, Jonas RA: University of Wisconsin cerebroplegia in a piglet survival model of circulatory arrest. Ann Thorac Surg 60:S494-S500, 1995.

8. Hindman BJ, Dexter F, Cutkomp J, Smith T: Diaspirin cross-linked hemoglobin does not increase brain oxygen consumption during cardiopulmonary bypass in rabbits. Anesthesiology 83:1302-1311, 1995.

9. Robbins RC, Balaban RS, Swain JA: Intermittent hypothermic asanguineous cerebral perfusion (cerebroplegia) protects the brain during prolonged circulatory arrest. A phosphorus 31 nuclear magnetic resonance study. J Thorac Cardiovasc Surg 99:878-884, 1990.

10. Runge TM, McGinity JW, Frisbee SE, Briceno JC, Ottmers SE, Calhoon JH, Hantler CB, Korvick DL, Ybarra JR: Enhancement of brain PO2 during cardiopulmonary bypass using a hyperosmolar oxygen carrying solution. Artif Cells Blood Substit Immobil Biotechnol 25:297-308, 1997.

Congenital Heart Surgery

1. Aoki M, Jonas RA, Nomura F, Stromski ME, Tsuji MK, Hickey PR, Holtzman DH: Effects of aprotinin on acute recovery of cerebral metabolism in piglets after hypothermic circulatory arrest. Ann Thorac Surg. 58:146-53, 1994

2. Aoki M, Nomura F, Stromski ME, Tsuji MK, Fackler JC, Hickey PR, Holtzman DH, Jonas RA: Effects of pH on brain energetics after hypothermic circulatory arrest. Ann Thorac Surg 55:1093-1103, 1993.

3. Ashwal S, Holshouser BA, Hinshaw DB Jr, Schell RM, Bailey L: Proton magnetic resonance spectroscopy in the evaluation of children with congenital heart disease and acute central nervous system injury. J Thorac Cardiovasc Surg 112:403-14, 1996.

4. Astudillo R, van der Linden J, Ekroth R, Wesslen O, Hallhagen S, Scallan M, Shore D, Lincoln C: Absent diastolic cerebral blood flow velocity after circulatory arrest but not after low flow in infants. Ann Thorac Surg 56:515-9, 1993.

+5. Bellinger DC, Jonas RA, Rappaport LA, Wypij D, Wernovsky G, Kuban KC, Barnes PD, Holmes GL, Hickey PR, Strand RD, Walsh AZ, Helmers SL, Constantinou JE, Carrazana EJ, Mayer JE, Hanley FL, Castaneda AR, Ware JH, Newburger JW: Developmental and neurologic status of children after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. N Engl J Med. 332:549-55, 1995.

6. Bissonnette B, Holtby HM, Davis AJ, Pua H, Gilder FJ, Black M: Cerebral hyperthermia in children after cardiopulmonary bypass. Anesthesiology 93(3):611-8, 2000.

7. Burrows FA: Transcranial Doppler monitoring of cerebral perfusion during cardiopulmonary bypass. Ann Thorac Surg 56:1482-4, 1993.

8. Crittenden MD, Roberts CS, Rosa L, Vatsia SK, Datz D, Clark RE, Swain JA: Brain protection during circulatory arrest. Ann Thorac Surg 51:942-7, 1991.

9. Daubeney PE, Smith DC, Pilkington SN, Lamb RK, Monro JL, Tsang VT, Livesey SA, Webber SA: Cerebral oxygenation during paediatric cardiac surgery: identification of vulnerable periods using near infrared spectroscopy. Eur J Cardiothorac Surg 13:370-7, 1998.

10. DeLeon SY, Thomas C, Roughneen PT, King N, Lehne R, DeLeon AM, Walenga J, Pifarre R: Experimental evidence of cerebral injury from profound hypothermia during cardiopulmonary bypass. Pediatr Cardiol 19:398-403, 1998.

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12. Ekroth R, Rossi RF, Tsang V, Jackson AP, Thompson RJ, Scallan M, Lincoln C: Serial measurement of arterial and internal jugular venous creatine kinase isoenzyme BB (CK-BB) after deep hypothermic circulatory arrest in pediatric cardiac surgery. Thorac Cardiovasc Surg 34:223-5, 1986.

13. Fallon P, Aparicio JM, Elliott MJ, Kirkham FJ: Incidence of neurological complications of surgery for congenital heart disease. Arch Dis Child 72:418-22, 1995.

14. Greeley WJ, Kern FH, Meliones J, Ungerleider RM: Monitoring the brain during cardiac surgery in children. Can J Anaesth 40:291-7, 1993.

*15. Greeley WJ, Kern FH, Meliones JN, Ungerleider RM: Effect of deep hypothermia and circulatory arrest on cerebral blood flow and metabolism. Ann Thorac Surg 56:1464-6, 1993.

*16. Greeley WJ, Kern FH, Ungerleider RM, Boyd JL, Quill T, Smith LR, Baldwin B, Reves JG: The effect of hypothermic cardiopulmonary bypass and total circulatory arrest on cerebral metabolism in neonates, infants, and children. J Thorac Cardiovasc Surg 101:783-94, 1991.

*17. Greeley WJ, Bracey VA, Ungerleider RM, Greibel JA, Kern FH, Boyd JL, Reves JG, Piantadosi CA: Recovery of cerebral metabolism and mitochondrial oxidation state is delayed after hypothermic circulatory arrest. Circulation 84 (Suppl III):400-6, 1991.

18. Hindman BJ: Choice of alpha-stat or pH-stat management and neurologic outcomes after cardiac surgery: it depends. Anesthesiology 89:5-7, 1998.

19. Hiramatsu T, Jonas RA, Miura T, DuPlessis A, Tanji M, Forbess JM, Holtzman D: Cerebral metabolic recovery from deep hypothermic circulatory arrest after treatment with arginine and nitro-arginine methyl ester. J Thorac Cardiovasc Surg 112:698-707, 1996.

20. Holden KR, Sessions JC, Cure J, Whitcomb DS, Sade RM: Neurologic outcomes in children with post-pump choreoathetosis. J Pediatr 132:162-4, 1998.

*21. Kawata H, Fackler JC, Aoki M, Tsuji MK, Sawatari K, Offutt M, Hickey PR, Holtzman D, Jonas RA: Recovery of cerebral blood flow and energy state in piglets after hypothermic circulatory arrest versus recovery after low-flow bypass. J Thorac Cardiovasc Surg 106:671-85, 1993.

22. Kern FH, Ungerleider RM, Schulman SR, Meliones JN, Schell RM, Baldwin B, Hickey PR, Newman MF, Jonas RA, Greeley WJ: Comparing two strategies of cardiopulmonary bypass cooling on jugular venous oxygen saturation in neonates and infants. Ann Thorac Surg 60:1198-1202, 1995.

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25. Kimura T, Muraoka R, Chiba Y, Ihaya A, Morioka K: Effect of intermittent deep hypothermic circulatory arrest on brain metabolism. J Thorac Cardiovasc Surg 108:658-63, 1994.

26. Kirshbom PM, Skaryak LR, DiBernardo LR, Kern FH, Greeley WJ, Gaynor JW, Ungerleider RM: pH-stat cooling improves cerebral metabolic recovery after circulatory arrest in a pig model of aortopulmonary collaterals. J Thorac Cardiovasc Surg 111:147-55, 1996.

*27. Kirshbom PM, Skaryak LA, DiBernardo LR, Kern FH, Greeley WJ, Gaynor JW, Ungerleider RM: Effects of aortopulmonary collaterals on cerebral cooling and cerebral metabolic recovery after circulatory arrest. Circulation 92(9 Suppl):II490-4, 1995.

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29. Kurth CD, Priestley M, Golden J, McCann J, Raghupathi R: Regional patterns of neuronal death after deep hypothermic circulatory arrest in newborn pigs. J Thorac Cardiovasc Surg 118:1068-77, 1999.

30. Kurth CD, Steven JM, Nicolson SC, Jacobs ML: Cerebral oxygenation during cardiopulmonary bypass in children. J Thorac Cardiovasc Surg 113:71-8, 1997.

31. Kurth CD, Steven JM, Nicolson SC: Cerebral oxygenation during pediatric cardiac surgery using deep hypothermic circulatory arrest. Anesthesiology 82:74-82, 1995.

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33. Laycock GJ, Mitchell IM, Paton RD, Donaghey SF, Logan RW, Morton NS: EEG burst suppression with propofol during cardiopulmonary bypass in children: a study of the hemodynamic, metabolic and endocrine effects. Br J Anaesth 69:356-62, 1992.

34. LeBlanc JG, Blackstock D, Macnab AJ, Gagnon F, Gagnon R, Russell J, Ring T: Effects of propofol on cerebral oxygenation during cardiopulmonary bypass in children. Can J Anaesth 47(11):1082-9, 2000.

35. Lodge AJ, Undar A, Daggett CW, Runge TM, Calhoon JH, Ungerleider RM: Regional blood flow during pulsatile cardiopulmonary bypass and after circulatory arrest in an infant model. Ann Thorac Surg 63:1243-50, 1997.

36. Matheis G, Abdel-Rahman U, Braun S, Wimmer-Greinecker G, Esmaili A, Seitz U, Bastanier CK, Moritz A. Hofstetter R: Uncontrolled reoxygenation by initiating cardiopulmonary bypass is associated with higher protein S100 in cyanotic versus acyanotic patients. Thorac Cardiovasc Surg 48(5):263-8, 2000.

37. Mault JR, Whitaker EG, Heinle JS, Lodge AJ, Greeley WJ, Ungerleider RM: Cerebral metabolic effects of sequential periods of hypothermic circulatory arrest. Ann Thorac Surg 57:96-100, 1994.

38. McConnell JR, Fleming WH, Chu WK, Hahn FJ, Sarafian LB, Hofschire PJ, Kugler JD: Magnetic resonance imaging of the brain in infants and children before and after cardiac surgery. A prospective study. Am J Dis Child 144:374-8, 1990.

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