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Diabetic patients have abnormal cerebral autoregulation during cardiopulmonary bypass.

Publication ,  Journal Article
Croughwell, N; Lyth, M; Quill, TJ; Newman, M; Greeley, WJ; Smith, LR; Reves, JG
Published in: Circulation
November 1990

We tested the hypothesis that insulin-dependent diabetic patients with coronary artery bypass graft surgery experience altered coupling of cerebral blood flow and oxygen consumption. In a study of 23 patients (11 diabetics and 12 age-matched controls), cerebral blood flow was measured using 133Xe clearance during nonpulsatile, alpha-stat blood gas managed cardiopulmonary bypass at the conditions of hypothermia and normothermia. In diabetic patients, the cerebral blood flow at 26.6 +/- 2.42 degrees C was 25.3 +/- 14.34 ml/100 g/min and at 36.9 +/- 0.58 degrees C it was 27.3 +/- 7.40 ml/100 g/min (p = NS). The control patients increased cerebral blood flow from 20.7 +/- 6.78 ml/100 g/min at 28.4 +/- 2.81 degrees C to 37.6 +/- 8.81 ml/100 g/min at 36.5 +/- 0.45 degrees C (p less than or equal to 0.005). The oxygen consumption was calculated from jugular bulb effluent and increased from hypothermic values of 0.52 +/- 0.20 ml/100 g/min in diabetics to 1.26 +/- 0.28 ml/100 g/min (p = 0.001) at normothermia and rose from 0.60 +/- 0.27 to 1.49 +/- 0.35 ml/100 g/min (p = 0.0005) in the controls. Thus, despite temperature-mediated changes in oxygen consumption, diabetic patients did not increase cerebral blood flow as metabolism increased. Arteriovenous oxygen saturation gradients and oxygen extraction across the brain were calculated from arterial and jugular bulb blood samples. The increase in arteriovenous oxygen difference between temperature conditions in diabetic patients and controls was significantly different (p = 0.01). These data reveal that diabetic patients lose cerebral autoregulation during cardiopulmonary bypass and compensate for an imbalance in adequate oxygen delivery by increasing oxygen extraction.

Duke Scholars

Published In

Circulation

ISSN

0009-7322

Publication Date

November 1990

Volume

82

Issue

5 Suppl

Start / End Page

IV407 / IV412

Location

United States

Related Subject Headings

  • Xenon Radioisotopes
  • Risk Factors
  • Oxygen Consumption
  • Monitoring, Intraoperative
  • Middle Aged
  • Male
  • Humans
  • Homeostasis
  • Female
  • Diabetes Mellitus, Type 1
 

Citation

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Croughwell, N., Lyth, M., Quill, T. J., Newman, M., Greeley, W. J., Smith, L. R., & Reves, J. G. (1990). Diabetic patients have abnormal cerebral autoregulation during cardiopulmonary bypass. Circulation, 82(5 Suppl), IV407–IV412.
Croughwell, N., M. Lyth, T. J. Quill, M. Newman, W. J. Greeley, L. R. Smith, and J. G. Reves. “Diabetic patients have abnormal cerebral autoregulation during cardiopulmonary bypass.Circulation 82, no. 5 Suppl (November 1990): IV407–12.
Croughwell N, Lyth M, Quill TJ, Newman M, Greeley WJ, Smith LR, et al. Diabetic patients have abnormal cerebral autoregulation during cardiopulmonary bypass. Circulation. 1990 Nov;82(5 Suppl):IV407–12.
Croughwell, N., et al. “Diabetic patients have abnormal cerebral autoregulation during cardiopulmonary bypass.Circulation, vol. 82, no. 5 Suppl, Nov. 1990, pp. IV407–12.
Croughwell N, Lyth M, Quill TJ, Newman M, Greeley WJ, Smith LR, Reves JG. Diabetic patients have abnormal cerebral autoregulation during cardiopulmonary bypass. Circulation. 1990 Nov;82(5 Suppl):IV407–IV412.

Published In

Circulation

ISSN

0009-7322

Publication Date

November 1990

Volume

82

Issue

5 Suppl

Start / End Page

IV407 / IV412

Location

United States

Related Subject Headings

  • Xenon Radioisotopes
  • Risk Factors
  • Oxygen Consumption
  • Monitoring, Intraoperative
  • Middle Aged
  • Male
  • Humans
  • Homeostasis
  • Female
  • Diabetes Mellitus, Type 1