Cerebral vascular effects of aortovenous cannulations for pediatric cardiopulmonary bypass

The effects of aortovenous cannulations for pediatric cardiopulmonary bypass on cerebral blood flow velocity (CBFV) and electroencephalography (EEG) were evaluated. CBFV and EEG were continuously recorded before (baseline), during, and after cannulations until initiation of cooling (mean +/- 95% con...

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Veröffentlicht in:The Annals of thoracic surgery 2000-04, Vol.69 (4), p.1229-1235
Hauptverfasser: RODRIGUEZ, R. A, CORNEL, G, SPLINTER, W. M, WEERASENA, N. A, REID, C. W
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container_end_page 1235
container_issue 4
container_start_page 1229
container_title The Annals of thoracic surgery
container_volume 69
creator RODRIGUEZ, R. A
CORNEL, G
SPLINTER, W. M
WEERASENA, N. A
REID, C. W
description The effects of aortovenous cannulations for pediatric cardiopulmonary bypass on cerebral blood flow velocity (CBFV) and electroencephalography (EEG) were evaluated. CBFV and EEG were continuously recorded before (baseline), during, and after cannulations until initiation of cooling (mean +/- 95% confidence interval). Vasopressors and/or volume replacement were administered if mean arterial pressure (MAP) decreased below 35 mm Hg. Cannulation-related EEG slowing was used as a criterion for electrocortical alteration. We studied 124 children (3 days to 17 years of age). Aortic and venous cannulations decreased mean CBFV by 10+/-3% and 13+/-4%, respectively, from baseline (p < 0.001). MAP diminished (p < 0.01) by 8+/-3% and 12+/-4%, respectively, from precannulation values (53+/-2 mm Hg). Right atrial cannulation, which was often chosen because the patient was hemodynamically unstable, was more frequently associated with pharmacologic intervention when compared with superior vena cava (SVC) cannulation (p < 0.01). Transient EEG alterations (n = 20) were associated with persistently low MAP (< 30 mm Hg), low CBFV (< 69%), and aortic (n = 4) or SVC (n = 7) cannula malposition. Infants with right atrial cannulation and intervention had more frequent EEG alterations (p = 0.04). Patients requiring intervention were younger (p < 0.01) and had longer hospital stay (p < 0.01) than those without intervention. Cerebral effects of cannulations are greater in young infants. This was found to be associated with low MAP during heart manipulation or consequence of cannula malpositions.
doi_str_mv 10.1016/S0003-4975(99)01444-7
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Right atrial cannulation, which was often chosen because the patient was hemodynamically unstable, was more frequently associated with pharmacologic intervention when compared with superior vena cava (SVC) cannulation (p < 0.01). Transient EEG alterations (n = 20) were associated with persistently low MAP (< 30 mm Hg), low CBFV (< 69%), and aortic (n = 4) or SVC (n = 7) cannula malposition. Infants with right atrial cannulation and intervention had more frequent EEG alterations (p = 0.04). Patients requiring intervention were younger (p < 0.01) and had longer hospital stay (p < 0.01) than those without intervention. Cerebral effects of cannulations are greater in young infants. 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subjects Adolescent
Biological and medical sciences
Blood Pressure
Cardiac Catheterization
Cardiopulmonary Bypass
Cerebrovascular Circulation
Child
Child, Preschool
Electroencephalography
Heart Defects, Congenital - surgery
Hemodynamics
Humans
Infant
Infant, Newborn
Medical sciences
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the heart
title Cerebral vascular effects of aortovenous cannulations for pediatric cardiopulmonary bypass
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