Cardiopulmonary bypass, myocardial management, and support techniques Changes in autonomic response of the cerebral circulation after normothermic extracorporeal.

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Cardiopulmonary bypass, myocardial management, and support techniques Changes in autonomic response of the cerebral circulation after normothermic extracorporeal circulation Frank W. Sellke, MD, Steven Y. Wang, MD, PhD, Alon Stamler, MD, Robert G. Johnson, MD, William E. Cohn, MD, Ronald M. Weintraub, MD The Journal of Thoracic and Cardiovascular Surgery Volume 112, Issue 2, Pages 450-461 (August 1996) DOI: 10.1016/S0022-5223(96)70273-8 Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 1 Schematic of method to measure blood flow responses to internal carotid artery infusion of vasoactive substances (in vivo). A silicone elastomer catheter (A) was placed into the common carotid artery and advanced into the proximal internal carotid artery (B) for drug infusion. A perivascular Doppler flow probe (C) was used to measure internal carotid blood flow under baseline conditions and during the administration of vasoactive substances. Additional catheters (D, E) were placed in the internal carotid artery and high in the internal jugular vein (F) for pressure monitoring. The external carotid artery was ligated at its origin. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 450-461DOI: (10.1016/S0022-5223(96)70273-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 2 Schematic of in vitro microvessel apparatus. Cerebral microvessels were cannulated and pressurized in a no-flow state. With an inverted microscope connected to a video camera, the vessel image was projected onto a television monitor. An electronic dimension analyzer was used to measure internal lumen diameter, which was recorded on an oscillographic strip chart recorder. A, Brain; B, organ chamber; C, imaging apparatus. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 450-461DOI: (10.1016/S0022-5223(96)70273-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 3 Plot of mean aortic blood pressure as a function of time. Time of onset of CPB is designated as 0 minutes. Values are mean ± SEM. Asterisks represent p < 0.05 versus initial prebypass value. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 450-461DOI: (10.1016/S0022-5223(96)70273-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 4 Plot of internal carotid artery blood flow (unilateral) as a function of time. Time of onset of CPB is designated as 0 minutes. Values are mean ± SEM. Asterisks represent p < 0.05 versus initial prebypass value. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 450-461DOI: (10.1016/S0022-5223(96)70273-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 5 Plot of cerebral vascular resistance (unilateral) as a function of time. Time of onset of CPB is designated as 0 minutes. Values are mean ± SEM. Asterisks represent p < 0.05 versus initial prebypass value. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 450-461DOI: (10.1016/S0022-5223(96)70273-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 6 Change in internal carotid artery blood flow (percentage change from baseline) in response to the intraluminal administration of acetylcholine before CPB and after 2 hours of total CPB and 15 minutes of post-CPB perfusion (CPB-15min). Data are mean ± SEM. Asterisk represents p < 0.05 versus before CPB. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 450-461DOI: (10.1016/S0022-5223(96)70273-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 7 Change in internal carotid artery blood flow (percentage change from baseline) in response to the intraluminal administration of isoproterenol, before and after 2 hours of total CPB and 15 minutes of post-CPB perfusion (CPB-15min). Data are mean ± SEM. Asterisk represents p < 0.05 versus before CPB. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 450-461DOI: (10.1016/S0022-5223(96)70273-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 8 Change in internal carotid artery blood flow (percentage change from baseline) in response to the intraluminal administration of sodium nitroprusside, before and after 2 hours of total CPB and 15 minutes of post-CPB perfusion (CPB-15min). Data are mean ± SEM. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 450-461DOI: (10.1016/S0022-5223(96)70273-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 9 Plot of in vitro responses of precontracted porcine cerebral microvessels to the cholinergic agonist acetylcholine from uninstrumented animals in the absence (n = 6) or presence of NG-nitro-l-arginine (100 μmol/L, n = 6) or atropine (1 μmol/L, n = 6), or in microvessels denuded of endothelium (n = 6). Vessels were pressurized to 40 mm Hg in a no-flow state. Drugs were applied extraluminally. Responses are expressed as percentage relaxation of the U46619-induced vascular contraction. Daggers represent p < 0.01 versus microvessels with intact endothelium in the absence of any antagonist (control). The Journal of Thoracic and Cardiovascular Surgery 1996 112, 450-461DOI: (10.1016/S0022-5223(96)70273-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 10 Plot of in vitro responses of precontracted porcine cerebral microvessels to the cholinergic agonist acetylcholine from control animals (n = 6), animals after 2 hours of CPB and 15 minutes of perfusion after CPB (CPB-15min, n = 7), and animals after separation from CPB and 1 hour of cerebral perfusion after separation from CPB (CPB-60min, n = 6). Microvessels were pressurized to 40 mm Hg in a no-flow state. Drugs were applied extraluminally. Responses are expressed as percentage relaxation of the U46619-induced vascular contraction. Daggers represent p < 0.01 versus control. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 450-461DOI: (10.1016/S0022-5223(96)70273-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 11 Plot of in vitro responses of precontracted porcine cerebral microvessels to the β-adrenoceptor agonist isoproterenol from control animals (n = 6), animals after 2 hours of CPB and 15 minutes of perfusion after separation from CPB (CPB-15min, n = 7), and animals after CPB and 1 hour of cerebral perfusion after separation from CPB (CPB-60min, n = 6). In addition, the response of control vessels to isoproterenol in the presence of propranolol (1 μmol/L, PROP, n = 6) was examined. Microvessels were pressurized to 40 mm Hg in a no-flow state. Drugs were applied extraluminally. Responses are expressed as percentage relaxation of the U46619-induced vascular contraction. Asterisk represents p < 0.05 vs control at 0.1 μmol/L concentration; daggers represent p < 0.01 versus CPB-60min. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 450-461DOI: (10.1016/S0022-5223(96)70273-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 12 Plot of in vitro responses of precontracted porcine cerebral microvessels to the guanylate cyclase activator sodium nitroprusside from control animals (n = 6), animals after 2 hours of CPB and 15 minutes of perfusion after separation from CPB (CPB-15min, n = 7), and animals after CPB and 1 hour of cerebral perfusion after separation from CPB (CPB-60min, n = 6). Microvessels were pressurized to 40 mm Hg in a no-flow state. Drugs were applied extraluminally. Responses are expressed as percentage relaxation of the U46619-induced vascular contraction. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 450-461DOI: (10.1016/S0022-5223(96)70273-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 13 Plot of in vitro responses of precontracted porcine cerebral microvessels to the adenylate cyclase activator forskolin from control animals (n = 6), animals after 2 hours of CPB and 15 minutes of perfusion after separation from CPB (CPB-15min, n = 7), and animals after CPB and 1 hour of cerebral perfusion after separation from CPB (CPB-60min, n = 6). Microvessels were pressurized to 40 mm Hg in a no-flow state. Drugs were applied extraluminally. Responses are expressed as percentage relaxation of the U46619-induced vascular contraction. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 450-461DOI: (10.1016/S0022-5223(96)70273-8) Copyright © 1996 Mosby, Inc. Terms and Conditions