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Cerebral protection during surgical approach to the aortic arch aneurysms resection

Gaudêncio Lopes EspinosaI; Henrique MuradI; Antônio de Pádua JazbikI; Eduardo Sérgio BastosI; João de Deus e BritoI; José L FeitosaI; Rogério Antônio Silva BarrosII; Cláudio Miguel D'AvilaI

DOI: 10.1590/S0102-76381994000400002


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) whith 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 PaCO2 were analyzed to evaluate ischemic cerebral metabolic derangements. Hystopathological studies were also performed 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 method could afford cerebral protection against ischemia.


É realizado estudo experimental comparativo entre dois métodos de proteção cerebral na abordagem cirúrgica dos aneurismas do arco aórtico, avaliando a sua eficácia: hipotermia sistêmica profunda isolada (menor que 20ºC) com pinçamento arterial braquiocefálico e hipotermia sistêmica profunda associada à perfusão carotídea seletiva. Dois grupos de 15 cães cada foram submetidos, respectivamente, à hipotermia sistêmica profunda com pinçamento arterial braquiocefálico (Grupo I) e à hipotermia sistêmica profunda associada à perfusão seletiva da carótida direita (Grupo II). Foram analisadas amostras seriadas das alterações metabólicas de pH e PaCO2 que ocorreram no retorno venoso cerebral aferidas na veia julgular interna, bem como as alterações histopatológicas encontradas com 45 min., 90 min. e 135 min. de cada procedimento. Os resultados demonstram 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 de isquemia cerebral. Em períodos de 135 minutos os métodos tiveram resultados semelhantes, não oferecendo proteção cerebral adequada.
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Article receive on Thursday, March 10, 1994

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