Dissociation between Cerebral Autoregulation and Carbon Dioxide Reactivity during Nonpulsatile Cardiopulmonary Bypass

1985 ◽  
Vol 40 (6) ◽  
pp. 582-587 ◽  
Author(s):  
Tryggve Lundar ◽  
Karl-Fredrik Lindegaard ◽  
Tor Frøysaker ◽  
Rune Aaslid ◽  
Arne Grip ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Cardiopulmonary Bypass ◽  
Cerebral Autoregulation ◽  
Carbon Dioxide Reactivity

Assessment of dynamic cerebral autoregulation and cerebral carbon dioxide reactivity during normothermic cardiopulmonary bypass

2014 ◽  
Vol 53 (3) ◽  
pp. 195-203 ◽  
Author(s):  
Ervin E. Ševerdija ◽  
Erik D. Gommer ◽  
Patrick W. Weerwind ◽  
Jos P. H. Reulen ◽  
Werner H. Mess ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Cardiopulmonary Bypass ◽  
Cerebral Autoregulation ◽  
Carbon Dioxide Reactivity ◽  
Dynamic Cerebral Autoregulation

Cerebral Carbon Dioxide Reactivity during Nonpulsatile Cardiopulmonary Bypass

1986 ◽  
Vol 41 (5) ◽  
pp. 525-530 ◽  
Author(s):  
Tryggve Lundar ◽  
Karl-Fredrik Lindegaard ◽  
Tor Frøysaker ◽  
Arne Grip ◽  
Michael Bergman ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Cardiopulmonary Bypass ◽  
Carbon Dioxide Reactivity

Graded Hypercapnia and Cerebral Autoregulation during Sevoflurane or Propofol Anesthesia

2000 ◽  
Vol 93 (5) ◽  
pp. 1205-1209 ◽  
Author(s):  
Timothy J. McCulloch ◽  
Elizabeth Visco ◽  
Arthur M. Lam
Keyword(s):  
Carbon Dioxide ◽  
General Anesthesia ◽  
Cerebral Autoregulation ◽  
Carbon Dioxide Partial Pressure ◽  
Sevoflurane Anesthesia ◽  
Significant Difference ◽  
Autoregulation Index ◽  
Carbon Dioxide Reactivity ◽  
End Tidal ◽  
Artery Flow

Background Hypercapnia abolishes cerebral autoregulation, but little is known about the interaction between hypercapnia and autoregulation during general anesthesia. With normocapnia, sevoflurane (up to 1.5 minimum alveolar concentration) and propofol do not impair cerebral autoregulation. This study aimed to document the level of hypercapnia required to impair cerebral autoregulation during propofol or sevoflurane anesthesia. Methods Eight healthy subjects received a remifentanil infusion and were anesthetized with propofol (140 microg. kg-1. min-1) and sevoflurane (1.0-1.1% end tidal) in a randomized crossover study. Ventilation was adjusted to achieve incremental increases in arterial carbon dioxide partial pressure (Paco2) until autoregulation was impaired. Cerebral autoregulation was tested by increasing the mean arterial pressure (MAP) from 80 to 100 mmHg with phenylephrine while measuring middle cerebral artery flow velocity by transcranial Doppler. The autoregulation index, which has a value ranging from 0 to 1, representing absent to perfect autoregulation, was calculated, and an autoregulation index of 0.4 or less represented significantly impaired autoregulation. Results The threshold Paco2 to significantly impair cerebral autoregulation ranged from 50 to 66 mmHg. The threshold averaged 56 +/- 4 mmHg (mean +/- SD) during sevoflurane anesthesia and 61 +/- 4 mmHg during propofol anesthesia (P = 0.03). Carbon dioxide reactivity measured at a MAP of 100 mmHg was 30% greater than that at a MAP of 80 mmHg. Conclusions Even mild hypercapnia can significantly impair cerebral autoregulation during general anesthesia. There is a significant difference between propofol anesthesia and sevoflurane anesthesia with respect to the effect of hypercapnia on cerebral autoregulation. This difference occurs at clinically relevant levels of Paco2. When inducing hypercapnia, carbon dioxide reactivity is significantly affected by the MAP.

Validation of transcutaneous carbon dioxide monitoring using an artificial lung during adult pulsatile cardiopulmonary bypass

2021 ◽  
pp. 039139882098785
Author(s):  
Lawrence Garrison ◽  
Jeffrey B Riley ◽  
Steve Wysocki ◽  
Jennifer Souai ◽  
Hali Julick
Keyword(s):  
Carbon Dioxide ◽  
Cardiopulmonary Bypass ◽  
Gold Standard ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Artificial Lung ◽  
Blood Gas ◽  
Median Difference ◽  
Transcutaneous Carbon Dioxide ◽  
Arterial Blood

Measurements of transcutaneous carbon dioxide (tcCO2) have been used in multiple venues, such as during procedures utilizing jet ventilation, hyperbaric oxygen therapy, as well as both the adult and neo-natal ICUs. However, tcCO2 measurements have not been validated under conditions which utilize an artificial lung, such cardiopulmonary bypass (CPB). The purpose of this study was to (1) validate the use of tcCO2 using an artificial lung during CPB and (2) identify a location for the sensor that would optimize estimation of PaCO2 when compared to the gold standard of blood gas analysis. tcCO2 measurements ( N = 185) were collected every 30 min during 54 pulsatile CPB procedures. The agreement/differences between the tcCO2 and the PaCO2 were compared by three sensor locations. Compared to the earlobe or the forehead, the submandibular PtcCO2 values agreed best with the PaCO2 and with a median difference of –.03 mmHg (IQR = 5.4, p < 0.001). The small median difference and acceptable IQR support the validity of the tcCO2 measurement. The multiple linear regression model for predicting the agreement between the submandibular tcCO2 and PaCO2 included the SvO2, the oxygenator gas to blood flow ratio, and the native perfusion index ( R2 = 0.699, df = 1, 60; F = 19.1, p < 0.001). Our experience in utilizing tcCO2 during CPB has demonstrated accuracy in estimating PaCO2 when compared to the gold standard arterial blood gas analysis, even during CO2 flooding of the surgical field.

scholarly journals Risks for Impaired Cerebral Autoregulation During Cardiopulmonary Bypass and Postoperative Stroke

2013 ◽  
Vol 57 (6) ◽  
pp. 268
Author(s):  
M. Ono ◽  
B. Joshi ◽  
K. Brady ◽  
R. B. EASLEY ◽  
Y. Zheng ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Cerebral Autoregulation ◽  
Postoperative Stroke

Clinical evaluation of an instrument to measure carbon dioxide tension at the oxygenator gas outlet in cardiopulmonary bypass

Perfusion ◽  
2006 ◽  
Vol 21 (1) ◽  
pp. 21-26 ◽  
Author(s):  
Frode Kristiansen ◽  
Jan Olav Høgetveit ◽  
Thore H Pedersen
Keyword(s):  
Carbon Dioxide ◽  
Cardiopulmonary Bypass ◽  
Venous Blood ◽  
Carbon Dioxide Tension ◽  
Circuit Board ◽  
Separate Analysis ◽  
Blood Gas ◽  
Arterial Blood ◽  
Gas Measurement ◽  
Venous Blood Gas

This paper presents the clinical testing of a new capno-graph designed to measure the carbon dioxide tension at the oxygenator exhaust outlet in cardiopulmonary bypass (CPB). During CPB, there is a need for reliable, accurate and instant estimates of the arterial blood CO2 tension (PaCO2) in the patient. Currently, the standard practice for measuring PaCO2 involves the manual collection of intermittent blood samples, followed by a separate analysis performed by a blood gas analyser. Probes for inline blood gas measurement exist, but they are expensive and, thus, unsuitable for routine use. A well-known method is to measure PexCO2, ie, the partial pressure of CO2 in the exhaust gas output from the oxygenator and use this as an indirect estimate for PaCO2. Based on a commercially available CO2 sensor circuit board, a laminar flow capnograph was developed. A standard sample line with integrated water trap was connected to the oxygenator exhaust port. Fifty patients were divided into six different groups with respect to oxygenator type and temperature range. Both arterial and venous blood gas samples were drawn from the CPB circuit at various temperatures. Alfa-stat corrected pCO2 values were obtained by running a linear regression for each group based on the arterial temperature and then correcting the PexCO2 accordingly. The accuracy of the six groups was found to be (±SD): ±4.3, ±4.8, ±5.7, ±1.0, ±3.7 and ±2.1%. These results suggest that oxygenator exhaust capnography is a simple, inexpensive and reliable method of estimating the PaCO2 in both adult and pediatric patients at all relevant temperatures.

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