Efficacy of superficial temporal artery pressure-guided selective cerebral perfusion during deep hypothermic circulatory arrest in patients undergoing aortic arch surgery

Abstract

Objective To evaluate the efficacy of superficial temporal artery(STA)pressure-guided selective cerebral perfusion(SCP)during deep hypothermic circulatory arrest(DHCA)in patients undergoing aortic arch surgery. Methods Ninety-six patients of both sexes, aged 35-64 yr, with body mass index of 19-23 kg/m2, of American Society of Anesthesiologists physical status Ⅲ or Ⅳ, undergoing aortic arch surgery, were divided into STA pressure group(group A)and clinical experience group(group B)using a random number table, with 48 patients in each group.In group A, STA catheterization was performed after tracheal intubation, and arterial pressure was monitored.SCP flow was adjusted to maintain the target value of STA pressure between 30 and 40 mmHg during DHCA in group A. SCP flow rate was set at 5-10 ml·kg-1·min-1 according to clinical experience in group B. The volume of fluid perfused during SCP, emergence time, extubation time and duration of intensive care unit stay were recorded.Neurological function was evaluated during length of hospitalization after surgery, and the development of permanent and transient neurological dysfunction and mortality in hospital were recorded. Results Compared with group B, the volume of fluid perfused during SCP was significantly decreased, the emergence time, extubation time and duration of intensive care unit stay were shortened, the incidence of permanent and transient neurological dysfunction(2% and 4%, respectively)was decreased(P 0.05). Conclusion Maintaining STA pressure at 30-40 mmHg is a reliable method for guiding SCP during DHCA in patients undergoing aortic arch surgery. Key words: Temporal arteries; Blood pressure; Cerebrovascular circulation; Circulatory arrest, deep hypothermia induced; Prognosis