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Journal of Korean Neurosurgical Society 1996;25(2): 252-259.
Effects of Mannitol and Thiopental on Regional Cerebral Blood Flow, Somatosensory Evoked Potential and Neurologic Outcome During Reperfusion Following Complete Global Cerebral Ischemia in Cats.
Choon Keun Park, Sang Won Lee, Yung Sup Park, Seung Jin Choi, Pil Woo Huh, Dong Sup Chung, Joon Ki Kang, Chang Rak Choi
Department of Neurosugery, Catholic University Medical College, Seoul, Korea.
ABSTRACT
The cardiopulmonary bypass or cerebral circulation arrest is often used in the treatment of complex aneurysm or of arteriovenous malformation to decrease the risk of intraoperative aneurysm rupture. Although experimental studies have suggested that some drugs may protect the brain from ischemic injury, there are limitations in maintaining cerebral perfusion arrest without incurring neurologic deficits due to the initiation of detrimental processes including excitotoxic neuronal injury, activation of phospholipases, influx of calcium, and generation of damaging free radicals. The purpose of this study is to determine whether mannitol of thiopental has any favorable effects on the recovery of neurologic deficits and on the regional cerebral blood flow(rCBF), somatosensory evoked potential(SEP) and electroencephalogram(EEG) in cats which underwent 15 minutes-complete global ischemia-reperfusion. The complete global ischemia was produced in 38 cats by temporary intrathoracic occlusion of the innominate artery and the subclavian artery following ligation of bilateral mammary arteries and simultaneous induction of hypotension. The cats were allocatoed randomly to one of 4 treatment group: (1) control group, 8 cats received equal volume of saline solution; (2) thiopental group, 10 cats received 45mg/kg thiopental intravenously, (3) mannitol group, 10 cats received 2g/kg mannitol intravenously, (4) combined mannitol and thiopental group, 10 cats received equal dose of mannitol and thiopental intravenously. The drugs were administrated in a equally divided dosage before and after the ischemic episode. The results were as follows; 1) Eight animals which received saline showed the severe postischemic hypoperfusion and poor recovery of SEP and EEG, and 6 of them died within 6 hours after the ischemia. 2) Ten thiopental-treated animals also showed the severe postischemic hypoperfusion and poor recovery of SEP and EEG and 6 of them died within 6 hours after the ischemia. 3) Both mannitol-and combined treated groups showed early recovery of EEG, good recovery of SEP and EEG without the severe postischemic hypoperfusion, and 7 of 10 mannitol-treated animals and 8 of 10 combined treated animals were significantly recovered in all parameters. There were not significant differences in all parameters between the mannitol-and combined treated groups. 4) Thirty-four of 38 animals involved in this 15 minutes-ischemia resulted in the severe neurologic deficits inspite of treatment with mannitol, thiopental or both of them. These results suggest that, in cats, mannitol treatment is effective but not thiopental in preventing severe neurologic injury following complete global ischemia and the duration of complete ischemia should be far less than 15 minutes.
Key Words: Mannitol; Thipental; Reperfusion; Complete global cerebral ischemia
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