Microdialytical monitoring of uric and ascorbic acids in the brains of patients after severe brain injury and during neurovascular surgery

Objectives-Microdialysis has been extensively used to monitor brain metabol ism in the extracellular fluid of patients with severe head injury, to dete ct the onset of secondary ischaemic damage. The aim was to investigate whet her concentrations of uric and ascorbic acids were altered in such patients . Both these compounds play a part in free radical metabolism, which is acc elerated after ischaemia and brain injury. Methods-Patients with aneurysm or bypass operations were monitored intraope ratively to assess concentrations in minimally disturbed tissue. Afterwards , 13 patients with severe head trauma were monitored for up to 13 days in t he intensive care unit. Results-Intraoperatively, concentrations of both ascorbic and uric acids we re significantly higher in the bypass group than in patients with aneurysm, which might be attributed to chronic ischaemic conditions caused by the un ilateral occlusion of the carotid artery. In the patients with trauma, mean values of uric acid, varying between 6 muM and 180 muM, did not correlate with type of injury (contusion or diffuse) or duration of monitoring time. Patients who died had significantly higher concentrations of uric acid than those with a good outcome. Ascorbic acid could be detected only intermitte ntly, probably due to technical problems. Concentrations of these two compo unds could not be correlated with clinical findings during the course of mo nitoring. Conclusions-Although uric and ascorbic acids are influenced by ischaemic co nditions-for example, in bypass patients, neither compound is suitable for monitoring for free radical activity after severe head injury. Patients wit h a bad outcome tended to have higher concentrations of uric acid.