[The impact of neuroprotection on brain metabolism during carotid endarterectomy].

BACKGROUND: The primary objective of this study was to evaluate the impact of neuroprotection, administered during carotid endarterectomy, on brain metabolism. The secondary objective was to assess the impact on clinical outcome of the resulting changes to brain metabolism.

METHODS: A total of 35 patients underwent carotid endarterectomy with prophylactic combined neuroprotection (Sendai cocktail: Manitol, Phenhydan, Solumedrol, Tokoferol; Cerebrolysin; fraction of inspired oxygen (FiO2) = 1, middle arterial pressure (MAP) = 100 mm Hg, total intravenous anaesthesia--TIVA). The influence of neuroprotection on brain metabolism (S100B, glycaemia, lactate, pH, jugular vein bulb oxygen saturation--SvjO2) was evaluated. Metabolic parameters were acquired from the jugular bulb during surgery, just before unclamping of the vessel. The clinical outcome was evaluated by NIHSS (National Institutes of Health Stroke Scale). There were 35 patients in the control group who where operated on without any neuroprotection. The results from both groups of patients were compared and statistically analyzed.

RESULTS: Postoperative NIHSS did not change in any patients in either group. An intraoperative shunt was not inserted in any patients in either group. In the group with neuroprotection there were significantly higher levels of S100B (median 0.117 vs. 0.088; p < 0.0182), lactate (median 1.92 vs. 1.020; p < 0.0006), glycaemia (median 9.5 vs. 8.2; p < 0.0243), and SvjO2 (median 0.79 vs. 0.65; p < 0.0001). There were no postoperative changes to NIHSS in either group.

CONCLUSIONS: Neuroprotection administered before carotid endarterectomy influences some parameters of brain metabolism both positively and negatively, but with no impact on clinical outcome.