Introdução: a pressão intracraniana pode ser monitorada por meio de vários métodos que podem ser invasivos ou não invasivos. A ultrassonografia do nervo óptico é uma técnica não invasiva que permite mensurar a bainha deste nervo e detectar possíveis variações no seu diâmetro. O nervo óptico faz parte do sistema nervoso central de maneira contígua e é envolvido por uma bainha. Sendo assim, elevações ou reduções da pressão intracraniana podem ser transpostas à bainha deste nervo com consequente variação do seu diâmetro. Essas variações podem ser observadas pela ultrassonografia. Objetivo: determinar, por meio da ultrassonografia, o diâmetro da bainha do nervo óptico normal e avaliar os possíveis efeitos das drogas neste diâmetro durante a indução anestésica em suínos hígidos com pressão intracraniana normal. Métodos: foram selecionados 118 suínos híbridos saudáveis (64 fêmeas) de aproximadamente 20 kg e faixa etária similar. Todos os suínos foram submetidos à anestesia geral e foram devidamente monitorados. Os animais foram divididos em três grupos conforme os medicamentos utilizados: Grupo A: utilizando medicamento pré-anestésico xilazina e quetamina; Grupo B: utilizando xilazina (X), quetamina (Q) mais Propofol (P), e Grupo C: anestesiados com xilazina, quetamina e tiopental [tionembutal (T)]. As coletas das medidas nos três grupos foram feitas pelo aparelho de ultrassom em triplicata de cada olho, com os animais em posição laterolateral. Resultados: não houve diferenças estatisticamente significantes entre sexo e peso. O Diâmetro médio da bainha do nervo óptico em ambos os lados de cada grupo foram de 0,394±0,048 cm (X/Q), 0,407±0,029 cm (X/Q/P) e 0,378±0,042 cm (X/Q/T). Considerando todos os grupos, o diâmetro da bainha do nervo óptico variou de 0,287 cm a 0,512 cm (média 0,302 ± 0,039 cm). Houve diferenças estatisticamente significativas entre os grupos P e T (P > T, p = 0,003). Não foram detectadas diferenças significativas quando outros grupos foram comparados entre si. Conclusão: o diâmetro médio da bainha do nervo óptico, considerando todos os grupos, foi 0,302 ± 0,039 cm (0,287 cm - 0,512 cm) e 0,344 cm ± 0,048 cm nos indivíduos sedados apenas com X/Q / Introduction: the intracranial pressure can be monitored by various methods that may be invasive or non-invasive. Ultrasonography of the optic nerve is a technique non-invasive that allows measurement of the nerve sheath and detection of possible variations in its diameter noninvasively. The optic nerve is part of the central nervous system continuously and is surrounded by a sheath. Thus, with the increase or reduction of intracranial pressure, it can be transposed to the sheath of this nerve with consequent variation of its diameter. These variations can be observed through the ultrasound image. Objective: determine the normal optical nerve sheath diameter and to evaluate the possible effects of drugs on optical nerve sheath diameter during anesthetic induction in healthy pigs with normal intracranial pressure through ultrasound image. Methods:118 Healthy hybrid piglets from (64 female) the weighing approximately 20 kg each and of similar ages. All pigs underwent general anesthesia and were duly monitored. The animals were divided into three groups according to the medications used. Group A received preanesthetic xylazine and ketamine; Grupo B received xylazine, ketamine and propofol, and Grupo C received xylazine, ketamine, and thiopental (thionembutal). Measurements in the three groups were done by the ultrasound device in triplicate of each eye from the left and right sides. Results: There were no statistically significant differences between sex and weight. The mean optical nerve sheath sizes on both sides in each group were 0.394±0.048 cm (X/K), 0.407±0.029 cm (X/K/P) and 0.378±0.042 cm (X/K/T). Considering all the groups, the diameter of the optic nerve sheath varied from 0.287-0.512 cm (mean of 0.302±0.039 cm). There were statistically significant differences between the groups P and T (P > T, p=0.003). No statistically significant differences were detected when other groups were compared each other. Conclusion: The mean diameter of the optic nerve sheath considering all groups was 0.302±0.039 cm (0.287-0.512 cm) and 0.394±0.048 cm in the subjects only sedated with X/K

Submitted by Eunice Novais (enovais@uepg.br) on 2018-08-30T17:43:30Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Claudiane Ayres P.pdf: 1202728 bytes, checksum: 2b48ec7440eb9f77288374dd442bfe90 (MD5) / Made available in DSpace on 2018-08-30T17:43:30Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Claudiane Ayres P.pdf: 1202728 bytes, checksum: 2b48ec7440eb9f77288374dd442bfe90 (MD5) Previous issue date: 2018-02-27 / A pressão intracraniana (PIC) tem variações determinadas pelos ciclos respiratórios e cardíacos, portanto, acredita-se que lesões cardiovasculares podem ocasionar modificações na PIC. As doenças cardiovasculares (DCVs) estão dentre as principais causas de morte nos países desenvolvidos e em desenvolvimento e frequentemente, para o seu tratamento, torna-se necessário a realização de cirurgia cardíaca. Porém, pacientes submetidos a tais procedimentos desenvolvem complicações relacionadas a disfunções cardiopulmonares. A fim de minimizar as complicações decorrentes da cirurgia, a fisioterapia, como parte da reabilitação cardiopulmonar é capaz de controlar os sintomas respiratórios e melhorar a função cardiovascular, atuando através de exercícios aeróbicos e respiratórios. Este trabalho teve como objetivo monitorar a PIC, a força muscular respiratória e os sinais vitais de pacientes pré- e pós- cirurgia cardíaca e comparar os efeitos de dois protocolos de fisioterapia na recuperação da força muscular respiratória. Participaram do estudo 48 pacientes. Observou-se que as DCVs podem alterar a PIC de pacientes acometidos por tais patologias. Independente do protocolo utilizado, a realização da fisioterapia como parte da reabilitação cardiorrespiratória é benéfica para a recuperação cardiopulmonar dos pacientes submetidos à cirurgia cardíaca. / Intracranial pressure (ICP) has variations determined by respiratory and cardiac cycles, therefore, it is believed that cardiovascular lesions may cause changes in ICP. Cardiovascular diseases (CVDs) are among the leading causes of death in developed and developing countries, and it is often necessary to perform cardiac surgery for their treatment. However, patients submitted to such procedures develop complications related to cardiopulmonary dysfunctions. In order to minimize the complications resulting from surgery, physical therapy as part of cardiopulmonary rehabilitation is able to control respiratory symptoms and improve cardiovascular function by acting through aerobic and respiratory exercises. The objective of this study was to monitor ICP, respiratory muscle strength and vital signs of pre- and post-cardiac surgery patients, and to compare the effects of two physiotherapy protocols on respiratory muscle strength recovery. 48 patients participated in the study. It has been observed that CVDs can alter ICP in patients affected by such pathologies. Regardless of the protocol used, the performance of physiotherapy as part of cardiorespiratory rehabilitation is beneficial for the cardiopulmonary recovery of patients undergoing cardiac surgery.

A Pressão intracraniana (PIC) é um dos principais parâmetros fisiológicos em animais e humanos e sua morfologia é extremamente importante. Entretanto, todos os métodos de monitoramento existentes no mercado são invasivos, existindo uma ampla demanda por sistemas não invasivos, expandindo assim o campo de pesquisas acerca desse importante parâmetro neurológico, que só não é melhor estudado devido a forma invasiva de ser monitorado. A motivação é fazer com que o monitoramento da PIC seja tão comum e tão essencial quanto é hoje o monitoramento da pressão arterial, facilitando o diagnóstico e até prognóstico de diversas doenças. Este trabalho analisa e implementa melhorias de um sistema não invasivo de monitoramento da pressão intracraniana, baseado em extensometria. Um dos objetivos, no que tange o desenvolvimento do produto, é analisar o equipamento como um todo - Sensor, Hardware, Firmware e Software - e propor melhorias a partir dos testes realizados. Os testes realizados In vivo mostraram uma boa correlação do sinal com um sistema Gold Stardard, evidenciando o potencial promissor do método. / The intracranial pressure (ICP) is one of the main physiological parameters in animals and humans and its morphology is extremely important. However, all monitoring methods available in the market are invasive and there is a large demand for non-invasive systems, thus expanding the scope of research on this important neurological parameter, that just is not further studied because of the invasive method of monitoring. The motivation is to make monitoring the ICP as common and as essential, as monitoring the blood pressure is nowadays, facilitating diagnosis and even prognosis of various diseases. This work analyzes and implements improvements in a non-invasive intracranial pressure monitoring system based on extensometer. One of the goals, regarding product development, is to analyze the unit as a whole- Sensor, Hardware, Firmware and Software- and propose improvements from the tests. The in vivo tests showed a good correlation with a Gold Stardard system signal showing the promising potential of the method.

The neurological wake-up test, NWT, is a clinical monitoring tool that can be used to evaluate the level of consciousness in patients with traumatic brain injury (TBI) and subarachnoid haemorrhage (SAH) during neurocritical care (NCC). Since patients with severe TBI or SAH are often treated with mechanical ventilation and sedation, the NWT requires that the continuous sedation is interrupted. However, interruption of continuous sedation may induce a stress response and the use of the NWT in NCC is controversial. The effects of the NWT on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were evaluated in 21 patients with TBI or SAH. Compared to baseline when the patients were sedated with continuous propofol sedation, the NWT resulted in increased ICP and CPP (p<0.05). Next, the effects of the NWT on the stress hormones adrenocorticotrophic hormone (ACTH), cortisol, epinephrine and norepinephrine were evaluated in 24 patients. Compared to baseline, the NWT caused a mild stress response resulting in increased levels of all evaluated stress hormones (p<0.05). To compare the use of routine NCC monitoring tools, the choice of sedation and analgesia and the frequency of NWT in Scandinavian NCC units, a questionnaire was used. The results showed that all 16 Scandinavian NCC units routinely use ICP and CPP monitoring and propofol and midazolam were primary choices for patient sedation in an equal number of NCC units. In 2009, the NWT was not routinely used in eight NCC units whereas others used the test up to six times daily. Finally, intracerebral microdialysis (MD), brain tissue oxygenation (PbtiO2) and jugular bulb oxygenation (SjvO2) were used in 17 TBI patients to evaluate the effect of the NWT procedure on focal neurochemistry and cerebral oxygenation. The NWT did not negatively alter interstitial markers of energy metabolism or cerebral oxygenation. In conclusion, the NWT induced a mild stress response in patients with TBI or SAH that did not result in a detectable, significant secondary insult to the injured brain. These results suggest that the NWT may safely be used as a clinical monitoring tool in the NCC of severe TBI and SAH in a majority of patients.

During brain activity neurons release the major excitatory transmitter glutamate, which is taken up by astrocytes and converted to glutamine. Glutamine returns to neurons for re-conversion to glutamate. This glutamate-glutamine cycle is energy demanding. Glutamate turnover in injured brain was studied using an animal iron-induced posttraumatic epilepsy model and using neurointensive care data from 33 patients with spontaneous subarachnoid hemorrhage (SAH). Immunoblotting revealed that the functional form of the major astrocytic glutamate uptake protein GLT-1 was decreased 1-5 days following a cortical epileptogenic iron-injection, presumably due to oxidation-induced aggregation. Using microdialysis it was shown that the GLT-1 decrease was associated with increased interstitial glutamate levels and decreased interstitial glutamine levels. The results indicate a possible posttraumatic and post-stroke epileptogenic mechanism. Analysing 3600 microdialysis hours from patients it was found that the interstitial lactate/pyruvate (L/P) ratio correlate with the glutamine/glutamate ratio (r =-0.66). This correlation was as strong as the correlation between L/P and glutamate (r=0.68) and between lactate and glutamate (r=0.65). Pyruvate and glutamine correlated linearly (r=0.52). Energy failure periods, defined as L/P>40, were associated with high interstitial glutamate levels. Glutamine increased or decreased during energy failure periods depending on pyruvate. Energy failure periods were clinically associated with delayed ischemic neurological deficits (DIND) or development of radiologically verified infarcts, confirming that L/P>40 is a pathological microdialysis pattern that can predict ischemic deterioration after SAH. DIND-associated microdialysis patterns were L/P elevations and surges in interstitial glutamine. Glutamine and pyruvate correlated with the cerebral perfusion pressure (r=0.25, r=0.24). Glutamine and the glutamine/glutamate ratio correlated with the intracranial pressure (r=-0.29, r=0.40). Glutamine surges appeared upon substantial lowering of the intracranial pressure by increased cerebrospinal fluid drainage. Increased interstitial glutamine and pyruvate levels may reflect augmented astrocytic glycolysis in recovering brain tissue with increased energy demand due to a high glutamate-glutamine turnover.

During each cardiac cycle pulsatile arterial blood inflates the vascular bed of the brain, forcing cerebrospinal fluid (CSF) and venous blood out of the cranium. Excessive arterial pulsatility may be part of a harmful mechanism causing cognitive decline among elderly. Additionally, restricted venous flow from the brain is suggested as the cause of multiple sclerosis. Addressing hypotheses derived from these observations requires accurate and reliable investigational methods. This work focused on assessing the pulsatile waveform of cerebral arterial, venous and CSF flows. The overall aim of this dissertation was to explore cerebral blood flow and intracranial pulsatility using MRI, with respect to measurement, physiological and pathophysiological aspects. Two-dimensional phase contrast magnetic resonance imaging (2D PCMRI) was used to assess the pulsatile waveforms of cerebral arterial, venous and CSF flow. The repeatability was assessed in healthy young subjects. The 2D PCMRI measurements of cerebral arterial, venous and CSF pulsatility were generally repeatable but the pulsatility decreased systematically during the investigation. A method combining 2D PCMRI measurements with invasive CSF infusion tests to determine the magnitude and distribution of compliance within the craniospinal system was developed and applied in a group of healthy elderly. The intracranial space contained approximately two thirds of the total craniospinal compliance. The magnitude of craniospinal compliance was less than suggested in previous studies. The vascular hypothesis for multiple sclerosis was tested. Venous drainage in the internal jugular veins was compared between healthy controls and multiple sclerosis patients using 2D PCMRI. For both groups, a great variability in the internal jugular flow was observed but no pattern specific to multiple sclerosis could be found. Relationships between regional brain volumes and potential biomarkers of intracranial cardiac-related pulsatile stress were assessed in healthy elderly. The biomarkers were extracted from invasive CSF pressure measurements as well as 2D PCMRI acquisitions. The volumes of temporal cortex, frontal cortex and hippocampus were negatively related to the magnitude of cardiac-related intracranial pulsatility. Finally, a potentially improved workflow to assess the volume of arterial pulsatility using time resolved, four-dimensional phase contrast MRI measurements (4D PCMRI) was evaluated. The measurements showed good agreement with 2D PCMRI acquisitions. In conclusion, this work showed that 2D PCMRI is a feasible tool to study the pulsatile waveforms of cerebral blood and CSF flow. Conventional views regarding the magnitude and distribution of craniospinal compliance was challenged, with important implications regarding the understanding of how intracranial vascular pulsatility is absorbed. A first counterpoint to previous near-uniform observations of obstructions in the internal jugular veins in multiple sclerosis was provided. It was demonstrated that large cardiac- related intracranial pulsatility were related to smaller volumes of brain regions that are important in neurodegenerative diseases among elderly. This represents a strong rationale to further investigate the role of excessive intracranial pulsatility in cognitive impairment and dementia. For that work, 4D PCMRI will facilitate an effective analysis of cerebral blood flow and pulsatility.

Atliktas perspektyvusis stebėjimo tyrimas, kurio metu buvo tirti sunkią galvos smegenų traumą patyrę vaikai, gydyti KMUK Vaikų intensyviosios terapijos skyriuje. Pacientų būklė pagal GBS vertinta išvykstant iš gydymo įstaigos ir po šešių mėnesių. Darbo tikslas Nustatyti sunkią galvos smegenų traumą patyrusių vaikų ligos baigčių prognozinius veiksnius. Darbo uždaviniai 1. Įvertinti ankstyvas ir vėlyvas sunkią galvos traumą patyrusių vaikų ligos baigtis. 2. Nustatyti sunkią galvos traumą patyrusių vaikų vidinio kaukolės slėgio ir smegenų perfuzinio slėgio ryšį su ligos baigtimis. 3. Nustatyti sunkią galvos traumą patyrusių vaikų traumos pobūdžio ryšį su ligos baigtimis. 4. Nustatyti paciento būkės vertinimo skalių ir laboratorinių tyrimų kritines reikšmes ir jų prognozinę vertę. 5. Nustatyti laboratorinių tyrimų kritines reikšmes ir jų prognozinę vertę. Išgyveno 80,5 proc. sunkią galvos smegenų traumą patyrusių vaikų. Išvykstant iš gydymo įstaigos 50 proc. pacientų, o po šešių mėnesių – 24,2 proc. pacientų traumos baigtis buvos bloga. Įtakos traumos baigtims turėjo kraujavimas po kietuoju smegenų dangalu, smegenų edema, kaukolės kaulų lūžiai. Nustatytos laktatų, gliukozės kiekio kraujo serume, vaikų traumų skalės, Glazgo komų skalės ir vaikų mirštamumo indekso 2 kritinės reikšmės, prognozuojančios mirtį, blogą baigtį išvykstant iš gydymo įstaigos ir po šešių mėnesių. Dekompresinė kraniotomija, atlikta, kai VKS = 24,5 mmHg,o SPS = 46.5 mmHg ligos baigčių nepakeitė. / The prospective observational study involved children after severe traumatic brain injury treated in Pediatric Intensive Care Unit of Kaunas University of Medicine Hospital. The outcome according to Glasgow Outcome Scale was assessed on discharge and after six months The aim of the study was to determine the prognostic factors in children after severe traumatic brain injury. The objectives of the study: 1. To evaluate early and late outcomes in children after severe traumatic brain injury 2. To evaluate the relation of intracranial pressure and cerebral perfusion pressure with outcome in children after severe traumatic brain injury. 3. To evaluate the relation between type of injury and outcome. 4. To determine the threshold values for trauma scoring scales and to evaluate their prognostic significance. 5. To determine the threshold values for laboratory findings and to evaluate their prognostic significance. The survival rate was 80.5 %.half of patients had bad outcome on discharge and 24.4 % – had bad outcome after six months. The prognostic factors of outcome for children after severe traumatic brain injury were subdural hemorrhage, cerebral edema and skull fracture. Threshold values of Pediatric Trauma Score, Glasgow Coma Score and Pediatric index of Mortality 2 for death and bad outcomes on discharge and after six months were ascertained. Decompressive craniectomy performed at ICP ≥ 24.5 mmHg, CPP ≤ 46.5 mmHg had no impact on outcome in children after severe traumatic... [to full text]

A pressão intracraniana (PIC) é um dos principais parâmetros neurológicos em animais e humanos. A PIC é uma função da relação entre o conteúdo da caixa craniana (parênquima cerebral, líquido cefalorraquiano e sangue) e o volume do crânio. O aumento da PIC (hipertensão intracraniana) pode acarretar graves efeitos fisiológicos ou até mesmo o óbito em pacientes que não receberem rapidamente os devidos cuidados, os quais incluem o monitoramento em tempo real da PIC. Todos os métodos de monitoramento da PIC atualmente utilizados são invasivos, ou seja, é necessário introduzir um sensor de pressão no sistema nervoso central, acarretando aos pacientes riscos de infecções e traumas decorrentes do método. Neste trabalho desenvolvemos um método minimamente invasivo de monitoramento da pressão intracraniana, que consiste na utilização de sensores de deformação do tipo strain gauge fixados sobre a calota craniana. Os sinais oriundos deste sensor foram amplificados, filtrados e enviados para um computador com software apropriado para análise e armazenamento dos dados. O trabalho aqui apresentado objetivou os testes "in vivo" do sistema, onde foi utilizada mais de uma centena de animais em diversos testes, sendo que em todos os casos os resultados foram satisfatórios, apontando a eficácia do método. / The intracranial pressure (ICP) is one of the most important neurological parameter in animals and humans. The ICP is a function of the relation between the contents of the skull (brain parenchyma, cerebrospinal fluid and blood) and the volume of the skull. The increase in ICP (intracranial hypertension) may cause serious physiological effects and death in patients that do not receive appropriate care quickly, which includes real-time monitoring of ICP. All monitoring methods currently used in ICP are invasive, ie requiring invasion of the central nervous system by a pressure sensor, causing infections and traumas risks to patients. In this work we present a new minimally invasive method to monitor the intracranial pressure. This uses strain gauge deformation sensors, externally glued on the skull. The signal from this sensor is amplified, filtered and sent to a computer with appropriate software for analysis and data storage. "In vitro" and "in vivo" experiments let to the following results: (1) Our minimally invasive system is capable of adequately monitoring the ICP. (2) The measurements are in real and online time providing excellent signal and stability. (3) Simultaneous comparison with invasive methods not only validated our results but showed increased performance. The equipment cost effective will allow the use of our system in the Public Health System, with a important social aspect of our contribution.

Introdução: a pressão intracraniana pode ser monitorada por meio de vários métodos que podem ser invasivos ou não invasivos. A ultrassonografia do nervo óptico é uma técnica não invasiva que permite mensurar a bainha deste nervo e detectar possíveis variações no seu diâmetro. O nervo óptico faz parte do sistema nervoso central de maneira contígua e é envolvido por uma bainha. Sendo assim, elevações ou reduções da pressão intracraniana podem ser transpostas à bainha deste nervo com consequente variação do seu diâmetro. Essas variações podem ser observadas pela ultrassonografia. Objetivo: determinar, por meio da ultrassonografia, o diâmetro da bainha do nervo óptico normal e avaliar os possíveis efeitos das drogas neste diâmetro durante a indução anestésica em suínos hígidos com pressão intracraniana normal. Métodos: foram selecionados 118 suínos híbridos saudáveis (64 fêmeas) de aproximadamente 20 kg e faixa etária similar. Todos os suínos foram submetidos à anestesia geral e foram devidamente monitorados. Os animais foram divididos em três grupos conforme os medicamentos utilizados: Grupo A: utilizando medicamento pré-anestésico xilazina e quetamina; Grupo B: utilizando xilazina (X), quetamina (Q) mais Propofol (P), e Grupo C: anestesiados com xilazina, quetamina e tiopental [tionembutal (T)]. As coletas das medidas nos três grupos foram feitas pelo aparelho de ultrassom em triplicata de cada olho, com os animais em posição laterolateral. Resultados: não houve diferenças estatisticamente significantes entre sexo e peso. O Diâmetro médio da bainha do nervo óptico em ambos os lados de cada grupo foram de 0,394±0,048 cm (X/Q), 0,407±0,029 cm (X/Q/P) e 0,378±0,042 cm (X/Q/T). Considerando todos os grupos, o diâmetro da bainha do nervo óptico variou de 0,287 cm a 0,512 cm (média 0,302 ± 0,039 cm). Houve diferenças estatisticamente significativas entre os grupos P e T (P > T, p = 0,003). Não foram detectadas diferenças significativas quando outros grupos foram comparados entre si. Conclusão: o diâmetro médio da bainha do nervo óptico, considerando todos os grupos, foi 0,302 ± 0,039 cm (0,287 cm - 0,512 cm) e 0,344 cm ± 0,048 cm nos indivíduos sedados apenas com X/Q / Introduction: the intracranial pressure can be monitored by various methods that may be invasive or non-invasive. Ultrasonography of the optic nerve is a technique non-invasive that allows measurement of the nerve sheath and detection of possible variations in its diameter noninvasively. The optic nerve is part of the central nervous system continuously and is surrounded by a sheath. Thus, with the increase or reduction of intracranial pressure, it can be transposed to the sheath of this nerve with consequent variation of its diameter. These variations can be observed through the ultrasound image. Objective: determine the normal optical nerve sheath diameter and to evaluate the possible effects of drugs on optical nerve sheath diameter during anesthetic induction in healthy pigs with normal intracranial pressure through ultrasound image. Methods:118 Healthy hybrid piglets from (64 female) the weighing approximately 20 kg each and of similar ages. All pigs underwent general anesthesia and were duly monitored. The animals were divided into three groups according to the medications used. Group A received preanesthetic xylazine and ketamine; Grupo B received xylazine, ketamine and propofol, and Grupo C received xylazine, ketamine, and thiopental (thionembutal). Measurements in the three groups were done by the ultrasound device in triplicate of each eye from the left and right sides. Results: There were no statistically significant differences between sex and weight. The mean optical nerve sheath sizes on both sides in each group were 0.394±0.048 cm (X/K), 0.407±0.029 cm (X/K/P) and 0.378±0.042 cm (X/K/T). Considering all the groups, the diameter of the optic nerve sheath varied from 0.287-0.512 cm (mean of 0.302±0.039 cm). There were statistically significant differences between the groups P and T (P > T, p=0.003). No statistically significant differences were detected when other groups were compared each other. Conclusion: The mean diameter of the optic nerve sheath considering all groups was 0.302±0.039 cm (0.287-0.512 cm) and 0.394±0.048 cm in the subjects only sedated with X/K

Abstract There is a lack of reliable methods of evaluation of brain ischemic injury in patients undergoing cardiac surgery. The present study was, therefore, planned to evaluate whether serum S100β protein (I), brain cortical microdialysis (II), intracranial pressure (III) and electroencephalography (EEG) (IV) are predictive of postoperative death and brain ischemic injury in an experimental surviving porcine model of hypothermic circulatory arrest (HCA). One hundred and twenty eight (128) female, juvenile (8 to 10 weeks of age) pigs of native stock, weighing 21.0 to 38.2 kg, underwent cardio-pulmonary bypass prior to, and following, a 75-minute period of HCA at a brain temperature of 18°C. During the operation, hemodynamic, electrocardiograph and temperature monitoring was performed continuously. Furthermore, metabolic parameters were monitored at baseline, end of cooling, at intervals of two, four and eight hours after HCA and before extubation. Electroencephalographic recording was performed in all animals, serum S100β protein measurement in 18 animals, cortical microdialysis in 109 animals, and intracranial pressure monitoring in 58 animals. After the operation, assessment of behavior was made on a daily basis until death or elective sacrifice on the seventh postoperative day. All four studies showed that these parameters were predictive of postoperative outcome. Animals with severe histopathological injury had higher serum S100β protein levels at every time interval after HCA. Analysis of cortical brain microdialysis showed that the lactate/glucose ratio was significantly lower and the brain glucose concentration significantly higher among survivors during the early postoperative hours. Intracranial pressure increased significantly after 75 minutes of HCA, and this was associated with a significantly increased risk of postoperative death and brain infarction. A slower recovery of EEG burst percentage after HCA was significantly associated with the development of severe cerebral cortex, brain stem and cerebellum ischemic injury. In conclusion, serum S100β protein proved to be a reliable marker of brain ischemic injury as assessed on histopathological examination. Cerebral microdialysis is a useful method of cerebral monitoring during experimental HCA. Low brain glucose concentrations and high brain lactate/ glucose ratios after HCA are strong predictors of postoperative death. Increased intracranial pressure severely affected the postoperative outcome and may be a potential target for treatment. EEG burst percentage as a sum effect of anesthetic agent and ischemic brain damage is a useful tool for early prediction of severe brain damage after HCA. Among these monitoring methods, brain cortical microdialysis seems to be the most powerful one in predicting brain injury after experimental hypothermic circulatory arrest.