BACKGROUND: It is believed that the brain temperature is about 1oC higher than the peripheral temperature. However the result has been mostly obtained in normothermia patients. The objective of this study was to evaluate whether the brain and axillary temperature difference would be increased or decreased in hypothermic patients. METHODS: Sixty-six patients who underwent a craniotomy with implantation of the thermal diffusion flowmetry sensor (SABER 2000; Flowtornics, Phonics, USA) were included in this study. The temperature of the cerebral cortex and axilla were measured simultaneously every 2 hours. The patient groups were divided according to their axillary temperature, hyperthermia (over 38oC: 127 paired data), normothermia (36 38oC: 1626 paired data) and hypothermia (under 36oC: 285 paired data). A total 2048 paired sample data were collected and analyzed. RESULTS: The temperature difference between the cerebral cortex and the axilla was 0.46 +/- 1.04 oC in hyperthermic patients, 0.89 +/- 1.65 C in normothermia patients and 1.04 +/- 0.82 C in hypothermic patients. The temperature difference has statistical significance in each group (unpaired t-test, P > 0.05). CONCLSIONS: Our results demonstrate that the temperature difference in the brain shows a difference according to the patients, body temperature. In normothermia the temperature difference between the brain and the axilla was about 1oC. However in a hyperthermic state, the temperature difference decreased and in a hypothermic state, the temperature difference increased.
Axilla* ; Body Temperature* ; Brain* ; Cerebral Cortex ; Craniotomy ; Fever ; Humans ; Hypothermia ; Rheology ; Thermal Diffusion

OBJECTIVE: The brain temperature is about 0.4-1 degrees C higher than that of the other peripheral body area. But most of these results have been obtained in normothermic condition. The objective of this study is to evaluate the temperature difference between the brain and axilla, in patients under hypothermia. METHODS: Sixty-three patients(37 women and 26 men) who underwent craniotomy with implantation of the thermal diffusion flowmetry sensor were included in this study. The temperature of the cerebral cortex and axilla was measured every 2 hours, simultaneously. The patient group was divided according to axillary temperature hyperthermia(over 38 degrees C), normothermia(36-38 degrees C) and hypothermia(under 36 degrees C). Total 1671 paired sample data were collected and analyzed. RESULTS: The temperature difference between the cerebral cortex and the axilla was 0.45+/-1.04 degrees C in hyperthermic patients, 0.97+/-1.1 degrees C in normothermic patients and 1.04+/-0.81 degrees C in hypothermic patients. The temperature difference has statistical significance in each group(unpaired t-test, p<0.05). CONCLUSION: From our study the temperature difference between the brain and the axilla in hypothermic condition increased more than that of normothermic state. And in hyperthermic condition, the temperature difference decreased.
Axilla* ; Brain* ; Cerebral Cortex ; Craniotomy ; Female ; Fever ; Humans ; Hypothermia* ; Rheology ; Thermal Diffusion

BACKGROUND: This study was done to evaluate the sole effect of norepinephrine on the regional myocardial perfusion during displacement of the porcine beating heart using thermal diffusion method. METHODS: Thermal diffusion probe was inserted into the anterior myocardial wall during 20 procedures in 10 male pigs (30-35 kg). The measurements of regional myocardial perfusion and hemodynamic parameters were performed after complete instrumentation (baseline), after displacement of the beating heart anteriorly, and 5 and 15 minutes after norepinephrine infusion, titrated to restore baseline mean arterial pressure (MAP). RESULTS: Norepinephrine infusion reversed the decrease in MAP and myocardial perfusion, caused by displacement of the beating heart (62 +/- 3% to 115 +/- 4% of baseline, P < 0.01; 41 +/- 5% to 125 +/- 4% of baseline, P < 0.05, respectively). CONCLUSIONS: Restoration of MAP with norepinephrine infusion without any preload augmentation reversed deterioration in regional myocardial perfusion during displacement of the porcine beating heart.
Arterial Pressure ; Displacement (Psychology) ; Heart ; Hemodynamics ; Humans ; Male ; Norepinephrine ; ortho-Aminobenzoates ; Perfusion ; Swine ; Thermal Diffusion

BACKGROUND: To reduce massive blood loss during a hepatectomy, many anesthesiologists have used the technique of low central venous pressure maintenance by administration of low dose nitroglycerin (NTG) and/or intravenous fluid reduction. However, so far there have been no studies about local liver perfusion (LLP) changes after hepatic artery (HA) or portal vein (PV) reperfusion in patients receiving nitroglycerin administration. In this study, the changes in hemodynamics and LLP following HA and PV reperfusion along with low dose (2micro gram/kg/min) NTG administration in dogs were observed. METHODS: A total of 20 mongrel dogs were divided into four groups; HA occlusion and reperfusion group (H, n = 5), NTG administration group during the reperfusion on H (H-NTG, n = 5), PV occlusion and reperfusion group (P, n = 5), NTG administration group during the reperfusion on P (P-NTG, n = 5). After femoral and pulmonary arterial catheterization, a midline abdominal incision was made. HA and PV were exposed to clamp and declamp. A thermal diffusion microprobe was inserted in the liver parenchyme to measure LLP. RESULTS: The PV blood flow was not changed after HA occlusion, but HA blood flow increased after PV occlusion. The LLP decreased after HA and PV occlusion. The LLP recovered to the baseline level in group H-NTG after HA reperfusion, but the LLP was more increased compared to the baseline level in group H. In group P, the LLP did not recover after PV reperfusion, but the LLP in group P-NTG recovered to the baseline level after PV reperfusion. CONCLUSIONS: In conclusion, it was observed that the LLP recovered to the baseline level by administration of NTG after PV reperfusion. However, the LLP did not increase after HA reperfusion by administration of low dose NTG.
Animals ; Catheterization ; Catheters ; Central Venous Pressure ; Dogs* ; Hemodynamics* ; Hepatectomy ; Hepatic Artery* ; Humans ; Liver* ; Nitroglycerin* ; Perfusion* ; Portal Vein* ; Reperfusion* ; Thermal Diffusion

BACKGROUND: The measurement of perfusion is very important to understand the physiology of the tissue level. The QFlow(TM)400 perfusion measurement system is able to measure local tissue perfusion. The aim of this study was to validate thermal diffusion microprobe (TDM) in estimating myocardial blood flow during coronary artery occlusion and reperfusion in an animal beating heart model. METHODS: A total of 5 mongrel dogs were entered into the study. A left thoracotomy was performed under general anesthesia. After the left anterior descending coronary artery (LAD) was exposed, a TDM was inserted in the myocardium at the exposed LAD distributed area. The local myocardial perfusion was measured before, during and after LAD occlusion. To find the usefulness of TDM in a beating heart, k values were checked during the study. The k value or tissue conductivity should not exceed 6.23 mW/cmoC in this system. RESULTS: All the k values were below 6.23 mW/cmdegreesC in this study. Baseline local myocardial perfusion was 52.0 +/- 18.3 ml/min/100 g. During LAD occlusion, the local myocardial perfusion was decreased to 18.4 +/- 12.0 ml/min/100 g. At 10, 20 and 30 minutes after LAD reperfusion, the perfusion was recovered to 38.5 +/- 23.2, 27.2 +/- 17.4 and 36.2 +/- 17.2 ml/min/100 g, respectively, but the values at 20 and 30 minutes of reperfusion were significantly lower compared to baseline value. CONCLUSIONS: We could use the QFlow(TM)400 perfusion measurement system to measure myocardial injury produced by ischemia and subsequent reperfusion in a beating heart. With this system, we found that the local myocardial perfusion was not recovered to the baseline level in early state of the coronary reperfusion.
Anesthesia, General ; Animals ; Coronary Vessels* ; Dogs ; Heart* ; Ischemia ; Myocardial Reperfusion ; Myocardium ; Perfusion* ; Physiology ; Reperfusion* ; Thermal Diffusion* ; Thoracotomy

BACKGROUND: Carbon dioxide is a potent cerebral vasodilator. The change of carbon dioxide partial pressure may influence the intracranial pressure and the patients' neurological outcome. There are few reports about the influence of end-tidal CO2 (ETCO2), arterial CO2 (PaCO2) and its pressure difference P(a-ET)CO2 during a craniotomy on the Glasgow coma scale (GCS) score for evaluation of neurological status. In this study, authors tried to discover the influence of PaCO2, PETCO2, and P(a-ET)CO2 on neurological outcome. METHODS: The data of PaCO2 and PETCO2 and P(a-ET)CO2 during a craniotomy was saved. The correlations between each parameter, the GCS score and rCoBF were analyzed. To prevent a direct effect on carbon dioxide tension, blood pressure and body temperature were maintained within a normal range. At the same time, we inserted a probe of the thermal diffusion flowmetry monitor in the subdural space to monitor the regional cortical cerebral blood flow (rCoBF). All the data was saved simultaneously, at the moment of dura closure. RESULTS: There was a fair correlation between the PaCO2 and PETCO2. A low PaCO2 level correlated well with a good GCS score but, not with PETCO2. The mean P(a-ET)CO2 value was 4.4 +/- 3.1 mmHg. The high P(a-ET)CO2 level correlated well with a poor GCS score. High rCoBF correlated well with a good GCS score. However, the changes of PaCO2 and PETCO2 showed no correlations with the rCoBF. CONCLUSIONS: As a result, if we decrease the PaCO2 level by hyperventilation and increase the rCoBF level through proper management during anesthesia, we can improve the patients' neurological outcome.
Anesthesia ; Blood Pressure ; Body Temperature ; Carbon Dioxide ; Craniotomy* ; Glasgow Coma Scale ; Humans ; Hyperventilation ; Intracranial Pressure ; Partial Pressure ; Prognosis* ; Reference Values ; Rheology ; Subdural Space ; Thermal Diffusion

OBJECTIVE: The tolerance and the safety of temporary arterial occlusion in aneurysm surgery are variable among patients because of individual variations of their collateral circulation. We recorded continuous intraoperative regional cortical blood flow(rCoBF) with thermal diffusion flowmetry(TDF) in patients with aneurysmal subarachnoid hemorrhage to determine a safe time limit for temporary occlusion in relation to rCoBF. PATIENTS AND METHODS: From Oct. '97 to Sep. '98, 40 patients with cerebral aneurysm at anterior cerebral artery(ACA) or middle cerebral artery(MCA) were included in this study. The TDF probe was placed over the cortex which was supplied by corresponding arteries. For data analysis, we included only the patients with Hunt-Hess grade I or II on admission. RESULTS: The total occlusion time of the proximal parent artery in 24 patients was on average 21.8 minutes, ranging between 9 minutes and 68 minutes. The lowest rCoBF in relation to temporary occlusion time in patient with excellent outcome was as follows: 0ml/100mg/min for 13 minutes and 6ml/100mg/min(11% of basal rCoBF) for 18 minutes in the middle cerebral artery and bilateral anterior cerebral arteries, respectively. The multiple regression equation regarding safe time for temporary clipping was as follows: safe time = 5.5 + 0.06 X rCoBF intra + 0.25 X rCoBF pre. And reperfusion time for the full recovery of rCoBF was within 4 minute in most cases, except some no-reflow cases. CONCLUSION: In our study with proper brain protection, a safe time limit for temporary occlusion was calculated 18 minutes even at 0ml/100mg/min in the MCA and this technique seems to be very useful to detect a continuous real time change of rCoBF during aneurysm surgery.
Aneurysm* ; Anterior Cerebral Artery ; Arteries ; Brain ; Collateral Circulation ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery ; Parents ; Reperfusion ; Statistics as Topic ; Subarachnoid Hemorrhage ; Thermal Diffusion

BACKGROUND: The overall rate of renal complications after surgery on the suprarenal aorta remains high. Possible mechanisms are, a reduction and maldistribution of renal blood flow, activation of the renin-angiotensin system, and the release of various mediators. In this study, changes in renal blood flow, local renal perfusion, the oxygen extraction ratio, and in renal function by furosemide following supraceliac aortic cross clamping and unclamping were observed. METHODS: A total of 13 mongrel dogs were divided into two groups; a control group (n = 7), and a furosemide group (n = 6). For aortic cross clamping the supraceliac aorta was exposed and a doppler flowmeter probe was placed on the left renal artery. A thermal diffusion microprobe was also inserted in the renal parenchyme to measure local renal perfusion. Sixty minutes after aortic cross clamping, systemic hemodynamic data, renal blood flow, and local renal perfusion were measured. These parameters were also repeatedly measured at 1, 2, 3, 4, 5, and 6 hours after unclamping. Biomarkers of renal dysfunction and injury (renin activity, creatinine, and Cystatin-C) were measured. RESULTS: No differences were observed between the two groups in terms of renal blood flow, local renal perfusion, and oxygen extraction ratio. Renal blood flow and perfusion did not recover to the baseline level after unclamping in either group. Plasma renin activity significantly reduced in the furosemide group 3 hours after clamping, but serum creatinine, and Cystatin-C concentrations were similar in the tow groups. CONCLUSIONS: We conclude that the administration of furosemide after supraceliac aortic unclamping to improve renal function is not effective in experimental dogs.
Animals ; Aorta ; Aortic Aneurysm ; Biomarkers ; Constriction* ; Creatinine ; Dogs* ; Flowmeters ; Furosemide* ; Hemodynamics ; Oxygen ; Perfusion ; Plasma ; Renal Artery ; Renal Circulation ; Renin ; Renin-Angiotensin System ; Thermal Diffusion

PURPOSE: Various vasopressor agents are used to raise systemic vascular resistance (SVR) during liver transplantation. After grafted liver was reperfused, postreperfusion syndrome could be treated with various vasopressors. However, epinephrine can decrease the splanchnic perfusion and oxygen saturation and then hepatic blood flow would be jeopardized. Decreased hepatic blood flow might result in centrilobular necrosis which contributes to disruption of liver functions. We tried to know the effect of epinephrine on tissue perfusion of the liver. METHODS: In this study, measurement of hepatic microcirculation (HMC) and hemodynamic changes was performed in eight dogs to investigate the effect of vasopressors on hepatic microcirculation. Animals were divided into four groups in which low-dose epinephrine (0.05mug/Kg/min) and high-dose epinephrine (0.5mug/Kg/min) were randomly infused into the systemic vein and portal vein (1/6 of systemic dose) for ten minutes. Hepatic microcirculation was measured by Thermal Diffusion Probe. RESULTS: At low-dose systemic infusion of epinephrine, mean arterial bloodpressure (MABP), cardiac output (CO), and hepatic microcirculation (HMC) were significantly increased but systemic vascular resistance (SVR) was decreased. On high-dose epinephrine, MABP, CO (P=0.01), and SVR were significantly increased without changes of HMC. Intraportal infusion of low- and high-dose epinephrine increased hepatic vein pressure and SVR, respectively. CONCLUSION: These results would provide clues that systemic low-dose epinephrine infusion is enough to raise HMC and high-dose infusion of epinephrine to raise SVR could be used without jeopardizing HMC.
Animals ; Cardiac Output ; Dogs ; Epinephrine ; Hemodynamics ; Hepatic Veins ; Liver ; Liver Transplantation ; Microcirculation* ; Necrosis ; Oxygen ; Perfusion ; Portal Vein ; Thermal Diffusion* ; Transplants ; Vascular Resistance ; Vasoconstrictor Agents ; Veins

BACKGROUND: The Pringle maneuver is traditionally used during the hepatectomy to reduce the blood loss. However, there have been no studies about local liver perfusion (LLP) and oxygen extraction ratio (ERO2) following hepatic ischemia and reperfusion. In this study, the changes in hepatic blood flow (HBF), LLP, ERO2 following hepatic ischemia and reperfusion were observed. And the effects of low dose nitroglycerin (NTG) were observed too. METHODS: A total of 14 mongrel dogs were divided into two groups; control group (C, n = 7), NTG administration group (N, n = 7), NTG administration was started 5 minutes before HBF occlusion. After femoral arterial and central venous catheterization, midline abdominal incision was made. Hepatic artery (HA) and portal vein (PV) were exposed to clamp and declamp. And then doppler flowmeter probes were applied on HA and PV to measure their blood flow and a thermal diffusion microprobe was inserted in the liver parenchyme to measure LLP. RESULTS: The HA and PV blood flow, LLP, and ERO2 were not different between two groups. However, HBF more increased compared to the baseline level in N group after reperfusion. In C group, LLP did not recover after reperfusion. The LLP in N group recovered to the baseline level after reperfusion. CONCLUSIONS: In conclusion, it was observed that the HBF increased and LLP recovered to the baseline level after reperfusion by administration of low dose NTG. The use of low dose NTG is safe and effective for hepatectomy.
Animals ; Catheterization, Central Venous ; Central Venous Catheters ; Dogs* ; Flowmeters ; Hepatectomy ; Hepatic Artery ; Ischemia ; Liver* ; Nitroglycerin* ; Oxygen* ; Perfusion* ; Portal Vein ; Reperfusion* ; Thermal Diffusion