Effects of Phentolamine Infusion During Selective Cerebral Perfusion in Neonatal Piglets

    Authors

    I. R. Argueta-Morales; H. M. Munro; M. Olsen; C. Ionan; M. Nguyen; S. Amin; S. Danker; L. C. Meador;W. M. DeCampli

    Comments

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    Abbreviated Journal Title

    Ann. Thorac. Surg.

    Keywords

    HYPOTHERMIC CIRCULATORY ARREST; LOW-FLOW PERFUSION; AORTIC-ARCH; RECONSTRUCTION; APOPTOTIC NEURONAL INJURY; CARDIOPULMONARY BYPASS; BLOOD-FLOW; NEURODEVELOPMENTAL OUTCOMES; DEEP HYPOTHERMIA; CARDIAC-SURGERY; METABOLISM; Cardiac & Cardiovascular Systems; Respiratory System; Surgery

    Abstract

    Background. An optimal selective cerebral perfusion protocol in pediatric cardiac surgery is unknown. Phentolamine is frequently used in pediatric cardiopulmonary bypass. We sought to determine the effects of continuous phentolamine infusion during selective cerebral perfusion. Methods. Twenty-seven neonatal piglets (3.38 +/- 0.32 kg) were randomly assigned to 3 groups; sham (n = 7, anesthesia alone, no surgery or bypass), control (n = 10, saline infusion), or experimental (n = 10, phentolamine infusion 0.1 mg/kg per hour). Animals underwent 90 minutes of selective cerebral perfusion. Cerebral vascular resistance index (CVRI) and metabolic rate of oxygen (CMRO2) were determined every 15 minutes. Standardized sections of hippocampus, basal ganglia, and neocortex were obtained. Tissue samples were stained for caspase-3 and analyzed for positive apoptotic cell count. Data were analyzed with repeated measures and one-way analysis of variance. Results. The CVRI tended to increase over time in the control group and decrease over time in the experimental group, but difference was not statically significant (0.46 +/- 0.24 vs 0.39 +/- 0.10 mm Hg x min x kg(2/3)/mL, p = 0.15). Mean CMRO2 was higher in the control group compared with the experimental group (0.90 +/- 0.27 vs 0.59 +/- 0.12 mLO(2)/min x kg(2/3), p = 0.005) and decreased over time in both groups. The percentage of caspase-3 positive cells was significantly different among regions (hippocampus = 16.9 +/- 8.8; basal ganglia = 14.6 +/- 7.5; neocortex = 10.8 +/- 6.3; p < 0.0001) but not significantly different among sham (11.8% +/- 2.68%), control (14.4% +/- 2.24%), and experimental (15.5% +/- 2.24%) groups. Conclusions. A continuous infusion of phentolamine during selective cerebral perfusion significantly decreases CMRO2 and tends to decrease CVRI when compared with control. At the dose studied and at the time of tissue sampling, phentolamine does not appear to decrease apoptosis during or early after selective cerebral perfusion. (C) 2013 by The Society of Thoracic Surgeons

    Journal Title

    Annals of Thoracic Surgery

    Volume

    96

    Issue/Number

    6

    Publication Date

    1-1-2013

    Document Type

    Article

    Language

    English

    First Page

    2203

    Last Page

    2209

    WOS Identifier

    WOS:000327794000051

    ISSN

    0003-4975

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