TY - JOUR
T1 - Response of cerebral blood flow to phenylephrine infusion during hypothermic cardiopulmonary bypass
T2 - Influence of Pa(CO2) management
AU - Rogers, A. T.
AU - Stump, D. A.
AU - Gravlee, G. P.
AU - Prough, D. S.
AU - Angert, K. C.
AU - Wallenhaupt, S. L.
AU - Roy, R. C.
AU - Phipps, J.
PY - 1988
Y1 - 1988
N2 - Twenty-eight adult patients anesthetized with fentanyl, then subjected to hypothermic cardiopulmonary bypass (CPB), were studied to determine the effect of phenylephrine-induced changes in mean arterial pressure (MAP) on cerebral blood flow (CBF). During CPB patients managed at 28°C with either alpha-stat (temperature-uncorrected Pa(CO2) = 41 ± 4 mmHg) or pH-stat (temperature-uncorrected Pa(CO2) = 54 ± 8 mmHg) Pa(CO2) for blood gas maintenance received phenylephrine to increase MAP ≥ 25% (group A, n = 10; group B, n = 6). To correct for a spontaneous, time-related decline in CBF observed during CPB, two additional groups of patients undergoing CPB were either managed with the alpha-stat or pH-stat approach, but neither group received phenylephrine and MAP remained unchanged in both groups (group C, n = 6; group D, n = 6). For all patients controlled variables (nasopharyngeal temperature, Pa(CO2), pump flow, and hematocrit) remained unchanged between measurements. Phenylephrine data were corrected based on the data from groups C and D for the effect of diminishing CBF over time during CPB. In patients in group A CBF was unchanged as MAP rose from 56 ± 7 to 84 ± 8 mmHg. In patients in group B CBF increased 41% as MAP rose from 53 ± 8 to 77 ± 9 mmHg (P < 0.001). During hypothermic CPB normocarbia maintained via the alpha-stat approach at a temperature-uncorrected Pa(CO2) of ≃40 mmHg preserves cerebral autoregulation; pH-stat management (Pa(CO2) ≃57 mmHg uncorrected for temperature, or 40 mmHg when corrected to 28°C) causes cerebrovascular changes (i.e., impaired autoregulation) similar to those changes produced by hypercarbia in awake, normothermic patients.
AB - Twenty-eight adult patients anesthetized with fentanyl, then subjected to hypothermic cardiopulmonary bypass (CPB), were studied to determine the effect of phenylephrine-induced changes in mean arterial pressure (MAP) on cerebral blood flow (CBF). During CPB patients managed at 28°C with either alpha-stat (temperature-uncorrected Pa(CO2) = 41 ± 4 mmHg) or pH-stat (temperature-uncorrected Pa(CO2) = 54 ± 8 mmHg) Pa(CO2) for blood gas maintenance received phenylephrine to increase MAP ≥ 25% (group A, n = 10; group B, n = 6). To correct for a spontaneous, time-related decline in CBF observed during CPB, two additional groups of patients undergoing CPB were either managed with the alpha-stat or pH-stat approach, but neither group received phenylephrine and MAP remained unchanged in both groups (group C, n = 6; group D, n = 6). For all patients controlled variables (nasopharyngeal temperature, Pa(CO2), pump flow, and hematocrit) remained unchanged between measurements. Phenylephrine data were corrected based on the data from groups C and D for the effect of diminishing CBF over time during CPB. In patients in group A CBF was unchanged as MAP rose from 56 ± 7 to 84 ± 8 mmHg. In patients in group B CBF increased 41% as MAP rose from 53 ± 8 to 77 ± 9 mmHg (P < 0.001). During hypothermic CPB normocarbia maintained via the alpha-stat approach at a temperature-uncorrected Pa(CO2) of ≃40 mmHg preserves cerebral autoregulation; pH-stat management (Pa(CO2) ≃57 mmHg uncorrected for temperature, or 40 mmHg when corrected to 28°C) causes cerebrovascular changes (i.e., impaired autoregulation) similar to those changes produced by hypercarbia in awake, normothermic patients.
UR - http://www.scopus.com/inward/record.url?scp=0023813238&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0023813238&partnerID=8YFLogxK
U2 - 10.1097/00000542-198810000-00015
DO - 10.1097/00000542-198810000-00015
M3 - Article
C2 - 3177914
AN - SCOPUS:0023813238
SN - 0003-3022
VL - 69
SP - 547
EP - 551
JO - Anesthesiology
JF - Anesthesiology
IS - 4
ER -