Cerebral Energy State in Cardiac Surgery

Odense University Hospital10 enrolled

Overview

Impaired cerebral function remains an important complication of cardiopulmonary bypass (CPB) during cardiac surgery. The aim of the present study is to investigate whether the lactate to pyruvate (LP) ratio obtained by microdialysis (MD) of the cerebral venous outflow reflects a derangement of global cerebral energy state during cardiopulmonary bypass.

Patients undergoing primary, elective coronary artery bypass grafting were blindly randomized to usual range MAP (40 to 60 mmHg; n = 5) or intervention group MAP (60 to 80 mmHg; n = 5) during CPB. MD catheters were positioned in a retrograde direction in the internal jugular vein and a reference catheter was inserted into the brachial artery. The relations between LP ratio, MAP, data obtained from bi-frontal NIRS and neurological outcome measures were assessed.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

DIAGNOSTIC

Masking

NONE

Enrollment

Conditions

Postoperative; Dysfunction Following Cardiac Surgery

Interventions

MicrodialysisPROCEDURE

Extracerebral MD catheters were positioned in a retrograde direction in the internal jugular vein.

Eligibility

Sex: ALLMin age: 60 Years

Medical Language ↔ Plain English

Inclusion criteria: * Elective CABG on CPB Exclusion criteria: * Acute patients or reoperations * Patients with epidural catheter * Previous stroke * Stenotic carotids * Ejection fraction (EF) \< 50 % * Estimated per operative risk \> 5%

Locations (1)

Odense University Hospital

Odense, Fyn, Denmark

Outcomes

Primary Outcomes

Extracerebral microdialysis parameters

Does the LP ratio of cerebral venous blood increase significantly during CPB indicating compromised cerebral oxidative metabolism.The analyses included the variables routinely monitored during intracerebral microdialysis: glucose, pyruvate, lactate, glutamate, glycerol and lactate to pyruvate ratio.

Time frame: MD parameters were measured intraoperatively and for two hours postoperatively

Secondary Outcomes

Mini mental state examination (MMSE)

Patients were assessed preoperatively and postoperatively day two after surgery

Time frame: Neurological complications with in 2 days after surgery

Near-infrared spectroscopy (NIRS)

Right and left frontal rSO2 values were recorded simultaneously pre- and intraoperatively and for two hours postoperatively. Cerebral desaturation was defined as a decrease in the relative rSO2 value of 20 % compared with the individual pre-induction baseline value

Time frame: one day

Data from ClinicalTrials.gov

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