Cerebral effects of different prime solutions used during cardiopulmonary bypass

Background: This study aims to compare the cerebral, hemodynamic, and metabolic effects of different prime solutions used in patients undergoing coronary artery bypass grafting. Methods: Between May 2013 and May 2014, a total of 30 patients (25 males, 5 females; mean age: 59.5 +/- 9 years; range, 42 to 78 years) who were schedule for elective isolated coronary artery bypass grafting were included in this prospective study. The patients were randomized into three groups: Group 1 (n=10) (ringer's lactate [ RL]), Group 2 (n=10) (6% hydroxyethyl starch [HES] 130/0.4), and Group 3 (n=10) ( RL + 6% HES 130/0.4). Hemodynamic parameters, arterial blood gas analyses, hemoglobin, hematocrit, cerebral regional oxygen saturation, urine output and fluid balance were recorded preoperatively, before and after anesthesia, 10 min after the transition to extracorporeal circulation, while weaning from extracorporeal circulation, and at the end of surgery. Preoperatively and on postoperative Day 5, neuron-specific enolase enzyme and S-100 beta protein were assessed. On Day 5 and Week 3 postoperatively, the Standardized Mini- Mental Test was administered to the patients. Results: The serum neuron- specific enolase enzyme and S-100 beta protein levels of the patients were within physiological limits, and there were no clinical findings suggestive of cerebral damage, or changes in the Standardized Mini-Mental Test scores in any of the patients. There was a decrease of more than 20% of the baseline value of cerebral regional oxygen saturation in a total of four patients, one in Group 1 and three in Group 3. No significant difference was observed among the groups in terms of the other parameters. Conclusion: The prime solution content has no effect on the development of cerebral damage after cardiopulmonary bypass, and the main factor in preventing the development of cerebral damage was the preservation of cerebral perfusion, which can be achieved by monitoring cerebral perfusion in these patients.