We. Johnston et al., CEREBRAL METABOLIC CONSEQUENCES OF HYPOTENSIVE CHALLENGES IN HEMODILUTED PIGS WITH AND WITHOUT CARDIOPULMONARY BYPASS, Anesthesia and analgesia, 81(5), 1995, pp. 911-918
We tested the hypothesis that progressive aortic hypotension with bica
rotid occlusion produces greater reductions in cerebral blood flow (CB
F) and more flow-metabolism mismatching with hemodilution during cardi
opulmonary bypass (CPB) than with hemodilution alone. In Yorkshire pig
s randomized to hemodilution with CPB (n = 10) or hemodilution without
CPB (control; n = 9), the effects of bicarotid ligation and graded hy
potension on CBF (microspheres), the electroencephalogram (EEG), and c
ortical energy metabolites were examined. After bicarotid ligation, sy
stemic flow was reduced for 15-min intervals of 80, 60, and 40 mm Hg a
ortic pressure, followed by a cortical brain biopsy. At baseline, CBF
was lower in CPB (58 +/- 3 mL . 100 g(-1). min(-1)) than control (90 /- 3 mL . 100 g(-1). min(-1); P < 0.05) animals, as was cerebral oxyge
n metabolism (3.1 +/- 0.1 vs 4.2 +/- 0.2 mL . min(-1). 100 g(-1); P <
0.05). Although CBF remained 40% lower at each level of hypotension in
CPB than control animals (P < 0.05), EEG scores showed no intergroup
differences, indicating Similar flow-metabolism matching. Brain metabo
lites were similar between CPB and control groups (adenosine triphosph
ate, 9.6 +/- 2.4 vs 12.4 +/- 1.9,mu mol/g; adenosine diphosphate, 6.0
+/- 0.7 vs 6.3 +/- 0.4 mu mol/g; adenosine monophosphate, 4.8 +/- 0.9
vs 3.8 +/- 0.8 mu mol/g; creatine phosphate, 8.3 +/- 1.8 vs 7.9 +/- 1.
0 mu mol/g; and lactate, 178.4 +/- 20.2 vs 150.8 +/- 13.9 mu mol/g). T
hus, despite significantly lower CBF during hypotension with bicarotid
occlusion in hemodiluted animals during normothermic CPB, cortical el
ectrical activity and the balance between flow and :metabolism did not
differ from those in control animals without CPB.