Postoperative; Dysfunction Following Cardiac Surgery
Conditions
Keywords
Microdialysis, Cardiac surgery, Lactate to pyruvate ratio, Cardiopulmonary bypass, Neurological complications
Brief summary
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.
Detailed description
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.
Interventions
PROCEDUREMicrodialysis
Extracerebral MD catheters were positioned in a retrograde direction in the internal jugular vein.
Sponsors
Odense University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
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%
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Extracerebral microdialysis parameters | MD parameters were measured intraoperatively and for two hours postoperatively | 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. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mini mental state examination (MMSE) | Neurological complications with in 2 days after surgery | Patients were assessed preoperatively and postoperatively day two after surgery |
| Near-infrared spectroscopy (NIRS) | one day | 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 |
Countries
Denmark
Outcome results
None listed