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Cerebral protection to be used during aortic arch aneurysms resection

Henrique MuradI; Gaudêncio E LopesI; Antônio de Pádua JazbikI; Eduardo Sérgio BastosI; João de Deus e BritoI; José L FeitosaI; Rubens Giambroni FilhoI; Francisco José do NascimentoI; Márcia S PalharesI; Eliane C GomesI

DOI: 10.1590/S0102-76381993000300002


The authors proposition is to make an experimental study of two methods of cerebral protection to be used during aortic arch aneurysm resection. The methods to be evaluated were profound systemic hypothermia (under 20oC) with great vessels occlusion and profound systemic hypothermia with selective right carotid artery perfusion. Two groups of 15 dogs each were submitted either to profound systemic hypothermia with great vessels occlusion (GROUP I) or to profound systemic hypothermia with selective right carotid artery perfusion (GROUP II). Serial jugular vein samples for pH and PaC02 were analyzed to evaluate ischemic cerebral metabolic derangements. Hystopathological studies were also made at 45, 90 and 135 minutes, through animal sacrifice in each experiment. The results have shown good cerebral protection with both methods in the 45 minutes ischemic interval. At 90 minutes GROUP II method has conferred better cerebral protection than GROUP I. At 135 minutes of cerebral ischemia neither methods could afford cerebral protection against ischemia.


Os autores realizaram estudo experimental comparativo entre dois métodos de proteção cerebral utilizados na abordagem cirúrgica dos aneurismas do arco aórtico, avaliando a sua eficácia. Os métodos comparados foram a hipotermia sistêmica profunda isolada (menor que 20ºC) com pinçamento arterial braquiocefálico e a hipotermia sistêmica profunda associada à perfusão carotídea seletiva. Dois grupos de 15 cães cada foram submetidos, respectivamente, a hipotermia sistêmica profunda com pinçamento arterial braquiocefálico (GRUPO I) e a hipotermia sistêmica profunda associada a perfusão seletiva da carótida direita (GRUPO II). Foram colhidas amostras seriadas de sangue para análise das alterações metabólicas de pH e PaCO2 que ocorreram no retorno venoso cerebral, aferidas na veia jugular interna, bem como as alterações histopatológicas encontradas com 45 min, 90 min e 135 min de cada procedimento. Os resultados demonstraram que, apesar de ambos os métodos de proteção cerebral serem eficazes por um período de 45 minutos, o método utilizado no GRUPO II mostrou ser superior em períodos de até 90 minutos. Em períodos de 135 minutos os métodos tiveram resultados semelhantes, não oferecendo proteção cerebral adequada.
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