Monitoring of cognitive dysfunction during cardiopulmonary bypass and establishment of ideal cerebral management

• Project/Area Number: 14370491
• Research Category: Grant-in-Aid for Scientific Research (B)
• Allocation Type: Single-year Grants
• Section: 一般
• Research Field: Anesthesiology/Resuscitation studies
• Research Institution: Kagoshima University
• Principal Investigator: KANMURA Yuichi Kagoshima University, Graduate school of medical and dental sciences, Professor, 大学院・医歯学総合研究科, 教授 (30211189)
• Co-Investigator(Kenkyū-buntansha): KAKIHANA Yasuyuki Kagoshima University, University Hospital, Faculty of Medicine and Dentistry, Assistant Professor, 医学部・歯学部附属病院, 講師 (20264426) ; TOBO Kazumi Kagoshima University, University Hospital, Faculty of Medicine and Dentistry, Research Associate, 医学部・歯学部附属病院, 助手 (30325807)
• Project Period (FY): 2002 – 2004
• Project Status: Completed (Fiscal Year 2004)
• Budget Amount: ¥14,000,000 (Direct Cost: ¥14,000,000); Fiscal Year 2004: ¥2,200,000 (Direct Cost: ¥2,200,000); Fiscal Year 2003: ¥2,100,000 (Direct Cost: ¥2,100,000); Fiscal Year 2002: ¥9,700,000 (Direct Cost: ¥9,700,000)
• Keywords: Near-infrared spectroscopy / S-100β protein / SjvO2 / Cardiopulmonary bypass / post-operative brain injury / cytochrome oxidase / モノアミン / 脳高次機能障害 / 近赤外線分光法 / S-100b蛋白 / 内頚静脈血酸素飽和度

Research Abstract

Despite advances in the technology of cardiopulmonary bypass(CPB) and surgery, the fact still remains that some patients undergoing cardiac or thoracic aortic surgery suffer the obvious overwhelming complication of neurological dysfunction in the operative and perioperative periods. In this paper, to evaluate the accuracy of a few brain monitoring (S-100B, SjvO_2 or near-infrared spectroscopy(NIRS)) about detecting the occasion of cerebral injury during CPB, we studied patients who had undergone cardiac and/or thoracic aortic surgery with CPB. In the current study, there was no correlation between postoperative neurological complications and S 100B levels during CPB. Although our data indicate that the severity of neurological complication was indicated by the values obtained for late release S 100B at 12,24,and 48 h after CPB, the serum S-100B protein in the early phase(during CPB or less than 5 h after CPB) may be not a good predictor of the postoperative neurological prognosis. Furthermore, our data revealed three patterns of change in the redox behavior of cyt.ox.during the operation ; the actual pattern exhibited by a given patient showed a highly significant correlation with the neurological prognosis (p<0.0001), but hemoglobin oxygenation by NIRS and SjvO2 did not. In this study, the redox behavior of cyt.ox. during an operation is likely to be a good predictor of postoperative cerebral outcome, which implies that brain tissue oxygen sufficiency can be evaluated by near-infrared measurement of cytochrome oxidase. Furthermore, continuous monitoring of cyt.ox. shows great potential as a way of assessing interventive cerebroprotective regimens, and aggressive cerebral management with cyt.ox.monitoring may improve the postoperative neurological prognosis.

Research Products

• [Journal Article] The variable effects of dopamine among human isolated arteries commonly used for coronary bypass grafts (2004)
  • Author(s): Katai R, Tsuneyoshi I, Hamasaki J, Onomoto M, Suehiro S, Sakata R, Kanmura Y
  • Journal Title: Anesth Analg 98 Pages: 915-920
  • Description: 「研究成果報告書概要(和文)」より
• [Journal Article] Relationship between redox behavior of brain cytochrome oxidase and neurological prognosis (2003)
  • Author(s): Kakihana Y, Kuniyoshi T, Isowaki S, Tobo K, Nagata E, Okayama N, Kitahara K, Moriyama T, Omae T, Kawakami M, Kanmura Y, Tamura M
  • Journal Title: Adv Exp Med Biol 530 Pages: 413-419
  • Description: 「研究成果報告書概要(和文)」より
• [Journal Article] Re-evaluation of the reliability of cytochrome oxidase--signal study of cardiopulmonary bypass (2003)
  • Author(s): Kakihana Y, Kuniyoshi T, Isowaki S, Tobo K, Nagata E, Okayama N, Kitahara K, Moriyama T, Omae T, Kawakami M, Kanmura Y, Tamura M
  • Journal Title: Adv Exp Med Biol 540 Pages: 71-75
  • Description: 「研究成果報告書概要(和文)」より
• [Journal Article] Relationship between redox behavior of brain cytochrome oxidase and neurological prognosis (2003)
  • Author(s): Kakihana Y, Kuniyoshi T, Isowaki S, Tobo K, Nagata E, Okayama N, Kitahara K, Moriyama T, Omae T, Kawakami M, Kanmura Y, Tamura M
  • Journal Title: Adv Exp Med Biol 540 Pages: 71-75
  • Description: 「研究成果報告書概要(欧文)」より
• [Journal Article] Relationship between redox behavior of brain cytochrome oxidase and neurological prognosis (2003)
  • Author(s): Kakihana Y, Kuniyoshi T, Isowaki S, Tobo K, Nagata E, Okayama N, Kitahara K, Moriyama T, Omae T, Kawakami M
  • Journal Title: Adv Exp Med Biol 530 Pages: 413-419