Clinical Application of Compressed Spectral Array During Deep Hypothermia.
- Author:
Byung Chul CHAN
1
;
Sun Kook YOO
;
Sun Ho KIM
;
Jae Sung SONG
;
Sung Jei PARK
;
Jun Ho MOON
;
Joung Taek KIM
;
Young Lan KWAK
;
Yong Woo HONG
Author Information
1. Division of Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Total circulatory arrest, induced;
Hypothermia, induced;
Brain injury;
Electroencephalography
- MeSH:
Aorta, Thoracic;
Aortic Diseases;
Body Temperature;
Brain Injuries;
Brain Ischemia;
Electroencephalography;
Esophagus;
Humans;
Hypothermia*;
Hypothermia, Induced;
Ischemia;
Mortality;
Perfusion;
Rectum;
Rewarming
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
1997;30(8):752-759
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Profound hypothermia protects cerebral function during total circulatory arrest(TCA) in the surgical treatment of a variety of cardiac and aortic diseases. Despite its importance, there is no ideal technique to monitor the brain injury from ischemia. Since 1994, we have developed compressed spectral array(CSA) of electroencephalography(EEG) and monitored cerebral activity to reduce ischemic injury. The purposes of this study are to analyse the efficacy of CSA and to establish objective criteria to consistently identify the safe level of temperature and arrest time. We studied 6 patients with aortic dissection(AD, n=3) or aortic arch aneurysm(n=3, ruptured in 2). Body temperatures from rectum and esophagus and the EEG were monitored continuously during cooling and rewarming period. TCA with cerebral ischemia was performed in 3 patients and TCA with selective cerebral perfusion was performed in 3 patients. Total ischemic time was 30, 36 and 56 minutes respectively for TCA group and selective perfusion time was 41, 56 and 92 minutes respectively for selective perfusion group. The rectal temperatures for flat EEG were between 16.1 and 22.1 degrees C (mean:18.4+/-2.0); the esophageal temperatures between 12.7 and 16.4 degrees C(mean : 14.7+/-1.6). The temperatures at which EEG reappeared 5~15.4 degrees C for esophagus. There was no neurological deficit and no surgical mortality in this series. In summary, the electrical cerebral activity reappeared within 23 minutes at the temperature less than 16degrees C for rectum. It seemed that 15 degrees C of esophageal temperature was not safe for 30 minutes of TCA and continuous monitoring the EEG with CSA to identify the electrocerebral silence was useful.
