Novel Non-invasive Evaluation Method of Cerebral Microcirculation during hypothermic circulatory arrest using Laser Speckle Flowgraphy: A Pilot Study
FUMIAKI KIMURA1, HIROYUKI KAMIYA1, HIROTSUGU KANDA2, YUKI TOYAMA2, TAKAYUKI KUNISAWA2, TAIJI NAGAOKA3, AKITOSHI YOSHIDA3.
1Department of Cardiac surgery, Asahikawa Medical University, Asahikawa, Japan, 2Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Japan, 3Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan.
OBJECTIVE: The ophthalmic artery is the first branch of the internal carotid artery distal to the cavernous sinus. Branches of the ophthalmic artery supply ocular fundus, especially there are many small vessels around the optic nerve head (ONH). Thus, the blood flow of OHN reflects cerebral microcirculation. A laser speckle flowgraphy (LSFG) is a novel modality to evaluate ONH blood flow. Here we present our initial experience of LSFG measurement as a evaluation method of cerebral microcirculation during hypothermic circulatory arrest.
METHODS: In LSFG measurement, the mean blur rate (MBR) defined as an indicator of blood velocity and blood flow. In two patients undergoing total arch replacement with hypothermic circulatory arrest, MBR in ONH and regional cerebral oxygen saturation at forehead (rSO2) were measured at following points; T0: after anesthetic induction, T1: after establishment of cardiopulmonary bypass (CPB), T2: at the circulatory arrest with retrograde cerebral perfusion, T3: after initiation of antegrade cerebral perfusion (ACP), and T4: after cessation of CPB. The MBR value and the rSO2 value at T0 were defined as the baseline value. Measurement values at other points were demonstrated as percent values from the baseline.
RESULTS: In patient 1, MBR and rSO2 were 63% and 97% at T1, 7% and 74% at T2, 70% and 93% at T3 and 134% and 101% at T4, respectively. In patient 2, MBR and rSO2 were 75% and 88% at T1, 6% and 46% at T2, 75% and 122% at T3 and 100% and 160% at T4, respectively.
CONCLUSIONS: In this pilot study, deterioration of cerebral microcirculation during retrograde cerebral perfusion could be detected more sensitively with LSFG measurement than with rSO2 measurement. This novel modality may reveal further information of cerebral microcirculation in cardiac surgery.
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