The Clinical Experiement to Develop the Brain Protection Protocol in Cerebral Ischemia Using Compressed Spectral Array.

Min, Kyeong Tae; Kim, Sun Ho; Kim, Jong Hoon; Lee, Bae Hwan; Park, Seong Yong; Park, Eun Kyung; Lee, Kyu Chang

Original Article

Journal of Korean Neurosurgical Society 2002;32(4): 341-352.

Kyeong Tae Min, Sun Ho Kim, Jong Hoon Kim, Bae Hwan Lee, Seong Yong Park, Eun Kyung Park, Kyu Chang Lee

¹Department of Anesthesiology, College of Medicine, Yonsei Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
²Department of Neurosurgery, College of Medicine, Yonsei Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
³Clinical Research Center, College of Medicine, Yonsei Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

OBJECTIVE
The clinical experiment to establish the cerebral protection protocol for hemodynamically vulnerable patients from ischemic insult during surgery is presented.
METHODS
The experiment divided in two parts, one is to analyze the effect of intravenous anesthetics and inhalation anesthetics on EEG activity in neurologically intact 81 patients. The others is to develop the stepwise cerebral protection protocol during aneurysm surgery which required temporary clipping, carotid endarterectomy and extracranial intracranial arterial bypass surgery in 61 patients. The cerebral protection protocol included the use of intraoperative compressed spectral array(CSA) monitoring, induced hypertension, thiopental induced burst suppression and moderate hypothermia.
RESULTS
With the efforts of brain protection protocol, 59 of the 61 patients recovered without any newly developed neurological deficit from the surgery. One patient had carotid stenosis with multiple untreated aneurysms, and therefore, induced hypertension was not applied. This patient developed significant postoperative neurological deficits correlated well with the CSA changes. In one patient who has cerebral aneurysm, thiopental bolus injection was used. This patient has reduction of EEG activity during temporary clipping and developed the relatively well correlated neurologic deficit postoperatively. Among 28 carotid endarterectomy cases, three patients has definite reduction of EEG activities within 7 to 15 seconds of interval carotid artery(ICA) test clamping before endarterectomy. But, these patients recovered from surgery without any neurological deficit inspite of 28 to 35 minutes ICA clamping with the effort of thiopental induced burst suppression, induced hypertension and moderate hypothermia.
CONCLUSION
Cerebral protection protocol under CSA monitoring could prevent ischemic insults from circulatory disruption on vulnerable ischemic hemisphere.

Key Words: Cerebral protection; Carotid endarterectomy; Aneurysm surgery; Thiopental; Hypothermia; Temporary clipping