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Aneurysm IV: Nursing Management01:22

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Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...

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2-Vessel Occlusion/Hypotension: A Rat Model of Global Brain Ischemia
09:29

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Published on: June 22, 2013

Perfusing the cold brain: optimal neuroprotection for aortic surgery.

James C Halstead1, Christian Etz, D Matthias Meier

  • 1Department of Cardiothoracic Surgery, Division of Biostatistics, Mount Sinai School of Medicine, New York, New York 10029, USA. jameschalstead@yahoo.co.uk

The Annals of Thoracic Surgery
|August 28, 2007
PubMed
Summary

Selective cerebral perfusion (SCP) offers better brain protection during hypothermia than hypothermic circulatory arrest (HCA). While continuous SCP is optimal, a short HCA period may be acceptable, but prolonged HCA causes brain injury.

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Area of Science:

  • Cardiovascular Surgery
  • Neuroprotection
  • Hypothermia

Background:

  • Selective cerebral perfusion (SCP) is used with hypothermia during aortic surgery for neuroprotection.
  • Optimal implementation of SCP remains unclear despite its common use.

Purpose of the Study:

  • To investigate the physiological characteristics and behavioral benefits of different hypothermic circulatory arrest (HCA) and SCP protocols.

Main Methods:

  • A porcine model was used with 30 pigs cooled to 15°C.
  • Pigs were assigned to 90 min HCA, 30 min HCA + 60 min SCP, or 90 min SCP.
  • Cerebral blood flow (CBF) and oxygen consumption (CMRO2) were measured, along with postoperative neurobehavioral scores.

Main Results:

  • Cerebral blood flow was significantly higher during SCP when preceded by HCA.
  • Cerebral oxygen consumption was higher in the 30 min HCA + 60 min SCP group compared to 90 min SCP.
  • Postoperative neurobehavioral scores were significantly worse after 90 min HCA.

Conclusions:

  • Continuous SCP provides the best overall brain protection.
  • An initial period of HCA does not appear to impair late outcomes.
  • Prolonged HCA (90 minutes) results in permanent brain injury.