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Ann Thorac Surg 1989;48:769-775
© 1989 The Society of Thoracic Surgeons

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Articles

Cerebral vasoreactivity to carbon dioxide during cardiopulmonary perfusion at normothermia and hypothermia

Departments of Thoracic Surgery, Anesthesiology, and Clinical Neurophysiology, University Hospital, Lund, Sweden

Accepted for publication June 23, 1989.

^_* Address reprint requests to Dr Johnsson, Department of Thoracic Surgery, Lund University Hospital, S-223 50 Lund, Sweden.

With the pH-stat acid-base regulation strategy during hypothermic Cardiopulmonary bypass (CPB), carbon dioxide (CO₂) is generally administered to maintain the partial pressure of arterial CO₂ at a higher level than with the alpha-stat method. With preserved CO₂ vasoreactivity during CPB, this induction of "respiratory acidosis" can lead to a much higher cerebral blood flow level than is motivated metabolically. To evaluate CO₂ vasoreactivity, cerebral blood flow was measured using a xenon 133 washout technique before, during, and after CPB at different CO₂ levels in patients who were undergoing coronary artery bypass grafting with perfusion at either hypothermia or normothermia. The overall CO₂ reactivity was 1.2 mL/100 g/min/mm Hg. There was no difference between the groups. The CO₂ reactivity was not affected by temperature or CPB. The induced hemodilution resulted in higher cerebral blood flow levels during CPB, although this was counteracted by the temperature-dependent decrease in the hypothermia group. After CPB, a transient increase in cerebral blood flow was noted in the hypothermia group, the reason for which remains unclear. The study shows that manipulation of the CO₂ level at different temperatures results in similar changes in cerebral blood flow irrespective of the estimated metabolic demand. This finding further elucidates the question of whether alpha-stat or pH-stat is the most physiological way to regulate the acid-base balance during hypothermic CPB.

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