THE EFFICACY OF RETROGRADE CEREBRAL PERFUSION

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Deep hyporthermic retrograde cerebral perfusion has been employed recently during operation on thoracic aorta. However the efficacy of of the methods are still controversial. Then we estimated the efficacy of retrograde cerebral perfusion (RCP) during circulatory arrest experimentally. Then dogs were used for estimating the efficacy of RCP in normothermic state. Near-infrared spectrophotometory (NIRS) was employed for measurement of cerebral metabolism and oxygenation according to the individual differences (perfusion flow, perfusion pressure, existence of valve in vein, etc.). And evoked cerebral potentials elicited by direct stimulation of the cord was employed for estimating cerebral function. In normothermic state, the dogs were divided into two groups. Group I (n=5) ; simple ciculatory arrest 15 min, reperfusion 60 min, Group II (n=S) ; RCP during ciculatory arrest 15 min, reperfusion 60 min. Results were as follows ; 1) NIRS was useful during RCP for detecting malperfusion of the brain mainly by valve of veins. 2) Evoked cerebral potentials elicited by direct stimulation of the cord was useful in the noisy circumstances compared with them by stimulation of the peripheral nerve (somatosensory cortical evoked potentials). 3) Under controlling cerebral perfusion by NIRS,potentials, latencies, time of their loss and recovering time of evoked potentials were analyzed in groupI and groupII.From this study, we concluded that the efficacy of retrograde cerebral perfusion during circulatory arrest is not enough for maintaining normothermic state. Then RCP might have possibility of cooling brain effectively through veins around it only during deep hypothermic circulatory arrest.