Arterial air embolism in the cat brain

Iatrogenic air embolism: pathoanatomy, thromboinflammation, endotheliopathy, and therapies

Iatrogenic vascular air embolism is a relatively infrequent event but is associated with significant morbidity and mortality. These emboli can arise in many clinical settings such as neurosurgery, cardiac surgery, and liver transplantation, but more recently, endoscopy, hemodialysis, thoracentesis, tissue biopsy, angiography, and central and peripheral venous access and removal have overtaken surgery and trauma as significant causes of vascular air embolism. The true incidence may be greater since many of these air emboli are asymptomatic and frequently go undiagnosed or unreported. Due to the rarity of vascular air embolism and because of the many manifestations, diagnoses can be difficult and require immediate therapeutic intervention. An iatrogenic air embolism can result in both venous and arterial emboli whose anatomic locations dictate the clinical course. Most clinically significant iatrogenic air emboli are caused by arterial obstruction of small vessels because the pulmonary gas exchange filters the more frequent, smaller volume bubbles that gain access to the venous circulation. However, there is a subset of patients with venous air emboli caused by larger volumes of air who present with more protean manifestations. There have been significant gains in the understanding of the interactions of fluid dynamics, hemostasis, and inflammation caused by air emboli due to in vitro and in vivo studies on flow dynamics of bubbles in small vessels. Intensive research regarding the thromboinflammatory changes at the level of the endothelium has been described recently. The obstruction of vessels by air emboli causes immediate pathoanatomic and immunologic and thromboinflammatory responses at the level of the endothelium. In this review, we describe those immunologic and thromboinflammatory responses at the level of the endothelium as well as evaluate traditional and novel forms of therapy for this rare and often unrecognized clinical condition.

Spontaneous Absorption of Cerebral Air Embolus Developed Accidentally during an Intra-arterial Procedure

Cerebral arterial air embolism (CAAE), although infrequent, is a complication that can occur at any time during an invasive medical procedure. We experienced two cases of CAAE during cerebral angiography accidentally. The author reports the two cases of CAAE wherein air emboli dissolved spontaneously and immediately under normal atmospheric pressure, not under therapeutic hyperbaric environment. One of the cases shows entire dissolution of the air embolus on the moving image. This report shows that arterial air embolus can be absorbed spontaneously, and air embolus size is one of the factors that influence air embolus dissolution besides hyperbaric oxygen condition.

Hyperbaric oxygen does not improve cerebral function when started 2 or 4 hours after cerebral arterial gas embolism in swine

OBJECTIVE

Hyperbaric oxygenation is the accepted treatment for cerebral arterial gas embolism. Although earlier start of hyperbaric oxygenation is associated with better outcome, it is unknown how much delay can be tolerated before start of hyperbaric oxygenation. This study investigates the effect of hyperbaric oxygenation on cerebral function in swine when initiated 2 or 4 hours after cerebral arterial gas embolism.

DESIGN

Prospective interventional animal study.

SETTING

Surgical laboratory and hyperbaric chamber.

SUBJECTS

Twenty-two Landrace pigs.

INTERVENTIONS

Under general anesthesia, probes to measure intracranial pressure, brain oxygen tension (PbtO2), and brain microdialysis, and electrodes for electroencephalography were placed. The electroencephalogram (quantified using temporal brain symmetry index) was suppressed during 1 hour by repeated injection of air boluses through a catheter placed in the right ascending pharyngeal artery. Hyperbaric oxygenation was administered using U.S. Navy Treatment Table 6 after 2- or 4-hour delay. Control animals were maintained on an inspiratory oxygen fraction of 0.4.

MEASUREMENTS AND MAIN RESULTS

Intracranial pressure increased to a mean maximum of 19 mm Hg (SD, 4.5 mm Hg) due to the embolization procedure. Hyperbaric oxygenation significantly increased PbtO2 in both groups treated with hyperbaric oxygenation (mean maximum PbtO2, 390 torr; SD, 177 torr). There were no significant differences between groups with regard to temporal brain symmetry index (control vs 2-hr delay, p = 0.078; control vs 4-hr delay, p = 0.150), intracranial pressure, and microdialysis values.

CONCLUSIONS

We did not observe an effect of hyperbaric oxygenation on cerebral function after a delay of 2 or 4 hours. The injury caused in our model could be too severe for a single session of hyperbaric oxygenation to be effective. Our study should not change current hyperbaric oxygenation strategies for cerebral arterial gas embolism, but further research is necessary to elucidate our results. Whether less severe injury benefits from hyperbaric oxygenation should be investigated in models using smaller amounts of air and clinical outcome measures.

Animal models of cerebral arterial gas embolism

Cerebral arterial gas embolism is a dreaded complication of diving and invasive medical procedures. Many different animal models have been used in research on cerebral arterial gas embolism. This review provides an overview of the most important characteristics of these animal models. The properties discussed are species, cerebrovascular anatomy, method of air embolization, amount of air, bubble size, outcome parameters, anesthesia, blood glucose, body temperature and blood pressure.

Effects of hyperbaric treatment in cerebral air embolism on intracranial pressure, brain oxygenation, and brain glucose metabolism in the pig*

OBJECTIVE

To evaluate the effects of hyperbaric oxygen treatment after cerebral air embolism on intracranial pressure, brain oxygenation, brain glucose/lactate metabolism, and electroencephalograph.

DESIGN

Prospective animal study.

SETTING

Hyperbaric chamber.

SUBJECTS

Eleven Landrace/Yorkshire pigs.

INTERVENTIONS

In 11 anesthetized pigs, intracranial pressure and brain oxygenation were measured with microsensor technology, brain glucose/lactate by microdialysis, and electroencephalograph by conventional methods. After injection of air into the internal carotid artery, animals were treated immediately (at 3 mins; t = 3) or at 60 mins (t = 60) with U.S. Navy Treatment Table 6 for 4.48 hrs.

RESULTS

At the end of hyperbaric oxygen treatment, intracranial pressure in the t = 60 group (39 +/- 8 mm Hg) was significantly higher than in the t = 3 group (27 +/- 6 mm Hg), brain oxygenation values for group t = 3 and t = 60 were 66 +/- 14 and 52 +/- 15 mm Hg, respectively (no significant difference from baseline), and there were no pathologic scores in the visually assessed electroencephalograph. However, there was a significant decrease in brain glucose and a significant increase in brain lactate in both groups at the end of the 5-hr study period.

CONCLUSIONS

Hyperbaric oxygen treatment initiated at both 3 and 60 mins after embolization decreased the deleterious effects of cerebral air embolism on intracranial pressure and brain metabolism. Therefore, this model appears suitable to test the application of hyperbaric oxygen treatment with a delay >60 mins after embolization, as is often the case in the clinical situation.

Gas embolism: pathophysiology and treatment

Based on a literature search, an overview is presented of the pathophysiology of venous and arterial gas embolism in the experimental and clinical environment, as well as the relevance and aims of diagnostics and treatment of gas embolism. The review starts with a few historical observations and then addresses venous air embolism by discussing pulmonary vascular filtration, entrapment, and the clinical occurrence of venous air emboli. The section on arterial gas embolism deals with the main mechanisms involved, coronary and cerebral air embolism (CAE), and the effects of bubbles on the blood-brain barrier. The diagnosis of CAE uses various techniques including ultrasound, perioperative monitoring, computed tomography, brain magnetic resonance imaging and other modalities. The section on therapy starts by addressing the primary treatment goals and the roles of adequate oxygenation and ventilation. Then the rationale for hyperbaric oxygen as a therapy for CAE based on its physiological mode of action is discussed, as well as some aspects of adjuvant drug therapy. A few animal studies are presented, which emphasize the importance of the timing of therapy, and the outcome of patients with air embolism (including clinical patients, divers and submariners) is described.

Effects of cerebral air embolism on brain metabolism in pigs

OBJECTIVES

Cerebral air embolism was induced in pigs and changes in intracranial pressure (ICP), brain oxygen (PbrO2), brain carbon dioxide (PbrCO2), brain pH (brpH) and glucose, lactate and pyruvate levels were used to characterize this model.

METHODS

In seven anesthetized pigs, ICP, PbrO2, PbrCO2 and brpH were measured continuously with multiparameter sensors and brain glucose metabolism by microdialysis. After injection of air into the internal carotid artery, these parameters were recorded for 2 h.

RESULTS

ICP increased (433%) from 12 +/- 1 to 52 +/- 8 mmHg (P < 0.05). PbrO2 decreased from 25.7 +/- 6.2 to 11.9 +/- 5.2 mmHg. PbrCO2 increased (109%) from 57.7 +/- 2.7 to 120.4 +/- 21.5 mmHg (P < 0.05). Brain glucose decreased (38%) from 3.05 +/- 0.91 to 1.91 +/- 0.55 mmol, while brain lactate increased (384%) from 1.36 +/- 0.15 to 5.22 +/- 0.53 mmol/l (P < 0.05).

CONCLUSIONS

Cerebral air embolism has a deleterious effect on ICP and brain metabolism. Therefore, this model may be suitable for testing therapeutic regimens in cerebral air embolism.

In vivo droplet vaporization for occlusion therapy and phase aberration correction

The objective was to determine whether a transpulmonary droplet emulsion (90%, <6 microm diameter) could be used to form large gas bubbles (>30 microm) temporarily in vivo. Such bubbles could occlude a targeted capillary bed when used in a large number density. Alternatively, for a very sparse population of droplets, the resulting gas bubbles could serve as point beacons for phase aberration corrections in ultrasonic imaging. Gas bubbles can be made in vivo by acoustic droplet vaporization (ADV) of injected, superheated, dodecafluoropentane droplets. Droplets vaporize in an acoustic field whose peak rarefactional pressure exceeds a well-defined threshold. In this new work, it has been found that intraarterial and intravenous injections can be used to introduce the emulsion into the blood stream for subsequent ADV (B- and M-mode on a clinical scanner) in situ. Intravenous administration results in a lower gas bubble yield, possibly because of filtering in the lung, dilution in the blood volume, or other circulatory effects. Results show that for occlusion purposes, a reduction in regional blood flow of 34% can be achieved. Individual point beacons with a +24 dB backscatter amplitude relative to white matter were created by intravenous injection and ADV.

Increased cerebral blood flow and cardiac output following cerebral arterial air embolism in sheep

1. The effects of cerebral arterial gas embolism on cerebral blood flow and systemic cardiovascular parameters were assessed in anaesthetized sheep. 2. Six sheep received a 2.5 mL injection of air simultaneously into each common carotid artery over 5 s. Mean arterial blood pressure, heart rate, end-tidal carbon dioxide and an ultrasonic Doppler index of cerebral blood flow were monitored continuously. Cardiac output was determined by periodic thermodilution. 3. Intracarotid injection of air produced an immediate drop in mean cerebral blood flow. This drop was transient and mean cerebral blood flow subsequently increased to 151% before declining slowly to baseline. Coincident with the increased cerebral blood flow was a sustained increase in mean cardiac output to 161% of baseline. Mean arterial blood pressure, heart rate and end-tidal carbon dioxide were not significantly altered by the intracarotid injection of air. 4. The increased cardiac output is a pathological response to impact of arterial air bubbles on the brain, possibly the brainstem. The increased cerebral blood flow is probably the result of the increased cardiac output and dilation of cerebral resistance vessels caused by the passage of air bubbles.

Air-filled ultrasound contrast agents do not damage the cerebral microvasculature or brain tissue in rats

RATIONALE AND OBJECTIVES

Air microemboli may damage the cerebral microvasculature. The aim of this study was to evaluate the safety of ultrasound contrast agents composed of air microspheres with regard to cerebral damage when administered into the arterial system (ie, when not filtered by the capillary system of the lungs).

METHODS

Three experimental methods were used in 75 rats after injection of either Albunex, Echovist, or Levovist into the left heart ventricle. The alkaline phosphatase (ALP) method to demonstrate small segmental brain capillary and arteriolar dilatations (SCADs), intravenous injections of Evans blue and fluorescence microscopy to detect increased vascular permeability (blood-brain barrier damage), and histologic examination of the brain to detect microinfarction. Intracardiac injections of saline, air, and corn oil were used as controls.

RESULTS

Brain microinfarcts and SCADs formation of the brain microvasculature occurred only after control injections with corn oil. None of the brains from animals that received ultrasound contrast agent showed gross discoloration, as an indication of increased vascular permeability, with the Evans blue/fluorescence microscopy method. Definite leakage of Evans blue occurred only after large doses (150 microL) of air.

CONCLUSIONS

This study indicates that ultrasound contrast media composed of air microspheres do not cause lesions of the brain microvasculature or parenchyma.

Transcranial Doppler microembolus detection in the identification of patients at high risk of perioperative stroke

OBJECTIVES

Perioperative ischaemic stroke is the leading cause of morbidity and mortality associated with carotid endarterectomy (CEA). The aim was to test the hypotheses that the detection of microembolic ultrasonic signals (MES) with transcranial Doppler ultrasound (TCD) during and after the operation may be of value in identifying patients at increased perioperative stroke risk.

DESIGN

Open prospective case series.

PATIENTS AND METHODS

Eighty-one consecutive patients undergoing CEA with TCD monitoring. Preoperative, intraoperative and interval postoperative TCD monitoring of the middle cerebral artery (MCA) ipsilateral to the operated carotid artery. On-line pre- and intraoperative MES counting and blinded off-line analysis of postoperative MES counts. End-points were any focal neurological deficit and death at 30 days postoperatively.

RESULTS

MES were detected in 94% of patients intraoperatively and 71% of cases during the first postoperative hour. MES counts ranged from 0 to 25 per operative phase (range of median counts 0-8) and from 0 to 212 per hour postoperatively (range of median counts 0-4). Eight cases (10%) developed postoperative MES counts greater than 50/h. Five of these eight cases evolved ischaemic neurological deficits in the territory of the insonated MCA, indicating a strong association between frequent postoperative microembolism and the development of early cerebral ischaemia (chi 2 = 34.2, p < 0.0001). Intraoperative MES were not associated with clinical outcome measures.

CONCLUSIONS

MES counts of greater than 50/h in the early postoperative phase of carotid endarterectomy are predictive of the development of ipsilateral focal cerebral ischaemia.

Recommendations for hyperbaric oxygen therapy of cerebral air embolism based on a mathematical model of bubble absorption

Transcranial doppler studies show that microscopic cerebral artery air emboli (CAAE) are present in virtually all patients undergoing cardiac surgery. Massive cerebral arterial air embolism is rare. If it occurs, hyperbaric oxygen therapy (HBO) is recommended as soon as surgery is completed. We used a mathematical model to predict the absorption time of CAAE, assuming that the volumes of clinically relevant CAAE vary from 10(-7) to at least 10(-1) mL. Absorption times are predicted to be at least 40 h during oxygenation using breathing gas mixtures of fraction of inspired oxygen approximately equal to 40%. When CAAE are large enough to be detected by computerized tomography, absorption times are calculated to be at least 15 h. Decreases in cerebral blood flow caused by the CAAE would make the absorption even slower. Our analysis suggests that if the diagnosis of massive CAAE is suspected, computerized tomography should be performed, and consideration should be given to HBO therapy if the CAAE are large enough to be visualized, even if patient transfer to a HBO facility will require several hours.

Microembolism in Cerebral Angiography

Using transcranial Doppler monitoring of middle cerebral artery blood flow velocity, a number of studies have detected transient high intensity embolic signals during cerebral angiography. These are particularly frequent during contrast injection, but also sometimes occur at the time of catheter and wire manipulations and following saline flushes. These embolic signals appear to be asymptomatic, although a correlation with subtle neurological damage, by neuropsychological evaluation for example, has not been made. Experimental studies in flow models and animal models suggest that the majority of these signals represent air emboli. These are most commonly introduced at the time the contrast is drawn up and at the time of contrast injection. The former can be reduced by allowing the contrast to stand prior to injection. The latter appears to be due to cavitation bubbles and can be reduced by reducing the speed of injection. Using current transcranial Doppler machines, it is impossible to be certain whether some of the embolic signals, particularly at times other than contrast injection, may be due to particulate, rather than air, emboli, but technological improvements may allow this distinction to be made in the future. (ECHOCARDIOGRAPHY, Volume 13, September 1996)

Cerebral arterial fat embolism in the rabbit

This study was designed to measure the effects of cerebral arterial fat embolism on cerebral blood flow and function. Rabbits were injected via the left internal carotid artery with the neutral triglyceride triolein. Left cerebral blood flow was measured by laser Doppler flowmetry, and left sided brain function by electrocorticogram and cortical somatosensory evoked responses following electrical stimulation of the forepaw. Readings were taken for 2 h before injection to establish a baseline, and for 3 h after injection. Cerebral blood flow was significantly decreased at 45 min after the injection of the lipid, then progressively decreased further to approximately 50% of baseline after 2 h, at which level it remained for the last hour of the experiment. The electrocorticogram was rapidly, but transiently, suppressed. The evoked responses did not differ from baseline at each of the time points measured. Using 125I-triolein, 2.49% of the injected dose was measured in the brain 3 min after injection. The results show that in this rabbit model of cerebral arterial fat embolism only a small percentage of injected lipid passes into the brain, but this is sufficient to cause a reduction in cerebral blood flow over the following 2 h. The evoked responses never alter significantly from baseline values.

Prostacyclin analogue TTC-909 reduces memory impairment in rats with cerebral embolism

The effects of the stable prostacyclin analogue TTC-909 on memory impairment in the water maze task and on neuronal damage were studied in rats with cerebral embolism induced by injecting polyvinyl acetate (PVA) into the right internal carotid artery and the ensuing embolism extending out into the right middle cerebral artery. Areas supplied by the lenticulostriate artery were most markedly damaged. In the water maze test, the PVA-embolized rats took longer to reach the platform than did the nontreated control rats. To some extent, repeated administrations of TTC-909 (200 ng/kg, IV) overcame this impairment in water maze learning in the rats. We assume that the vasodilating effects of TTC-909 maintain this blood supply to the ischemic area and that TTC-909 prevents the development of thrombosis around the PVA particles in the arterial capillaries, as a result of antiplatelet aggregative effects. These two mechanisms are likely to be involved in memory improvement. TTC-909 may prove effective for treating subjects with stroke and other cerebrovascular disorders.

Electroencephalographic study of divers with histories of neurological decompression illness

OBJECTIVE

To determine whether divers with histories of neurological decompression illness are electroencephalographically distinguishable from non-divers.

METHODS

The electroencephalograms (EEGs) from 68 divers with histories of neurological decompression illness and 45 non-diver controls were examined independently by two clinical neurophysiologists.

RESULTS

The diver and non-diver groups were electroencephalographically indistinguishable.

CONCLUSION

There is no electroencephalographic evidence for the existence of cerebral dysfunction in divers with histories of decompression illness.

Microscopic air embolism during cerebral angiography and strategies for its avoidance

Cerebral angiography is associated with a risk of neurological complications and air embolism may contribute towards this risk. To test this hypothesis, transcranial doppler ultrasonography was used to monitor the presence of air emboli in the middle cerebral arteries of 7 patients undergoing cerebral angiography. Doppler signals consistent with numerous air emboli were noted during each injection of radiographic contrast. This phenomenon was studied further in sheep. Radiographic contrast medium was injected into the carotid artery while a major carotid branch was insonated transorbitally. Embolic signals similar to those seen in patients were noted. Air was introduced at two points. First, at the time of drawing up the contrast into the syringe, especially with more viscous media. Standing the media before injection resulted in a highly significant reduction of air embolism, reducing the total mean duration of emboli from 1.32 (SD 0.60) s after immediate injection to 0.04 (0.05) s after ten minutes standing for iohexol 340 mg/mL (p < 0.001). Second, air was introduced at the time of injection, possibly by the formation of cavitation bubbles under pressure. This occurred most prominently with the less viscous contrast media and with saline, and was significantly reduced by slow injection (mean duration of emboli for saline 2.85 [2.43] s with fast injection compared with 0.32 [0.37] s with slow injection, p = 0.004). Air embolism may contribute towards neurological dysfunction after angiography. Measures should be taken to reduce this by allowing contrast media to stand prior to injection, and by flushing catheters with saline injected slowly.

Electroencephalography, evoked potentials and MRI brain scans in saturation divers. An epidemiological study

One hundred and fifty-six air and saturation divers, mean age 33.6 (range 21-49) years, were examined. The control group consisted of 100 offshore workers and policemen with the health requirements to have a diving certificate, mean age 34.0 (range 22-48) years. The examination protocol included electroencephalography (EEG), visual evoked potentials (VEPs), brain-stem auditory evoked potentials (BAEPs) and magnetic resonance imaging (MRI) of the brain and brain-stem. Abnormal EEGs, with focal slow waves mostly in the temporal regions and sharp potentials, were found in 18% of the divers and in 5% of the controls (P = 0.003). Abnormal EEGs correlated significantly with the exposure to saturation diving (P = 0.0006) and the prevalence of decompression sickness (P = 0.0102). Alcohol consumption was negatively correlated with abnormal EEGs (P = 0.0006). Mean I-III BAEP latency was increased (P = 0.047) in the diver group. P100 VEP latency decreased with age (21-49 years). High signal intensity changes obtained by MRI were found in 33% of the divers and in 43% of the controls (P = 0.14). It is concluded that the nervous system of saturation divers is influenced by their occupation and that EEG is a useful method in the health examination of divers.

Effect of lidocaine after experimental cerebral ischemia induced by air embolism

To investigate possible approaches to the treatment of neural damage induced by air embolism and other forms of acute cerebral ischemia, somatosensory evoked potentials (SEP's) were measured after cerebral air embolism in the anesthetized cat. Air was introduced into the carotid artery in increments of 0.08 ml until the SEP amplitude was reduced to approximately 10% or less of baseline values. Either a saline or lidocaine infusion was begun 5 minutes after inducing cerebral ischemia. In the saline-treated group, SEP amplitude was reduced to 6.7% +/- 1.6% (mean +/- standard error of the mean) of baseline, with a return to 32.6% +/- 4.7% of baseline over a 2-hour period. In the lidocaine-treated group, SEP amplitude was reduced to 5.9% +/- 1.5%, with a return to 77.3% +/- 6.2% over a 2-hour period. The results suggest that lidocaine administration facilitates the return of neural function after acute cerebral ischemia induced by air embolism.

The effects of a prophylactic bolus of lidocaine in focal cerebral ischaemia

In order to determine the cerebral protective effects of an intravenous bolus of 5 mg.kg-1 of lidocaine, the left middle cerebral artery (MCA) was transorbitally occluded in 19 cats. Ten animals received the lidocaine bolus and nine a similar volume of saline immediately before MCA occlusion. Somatosensory evoked potentials (SEP) were recorded before and after the lidocaine bolus as well as continually after MCA occlusion. After six hours of vessel occlusion and without reperfusion, the animals were sacrificed and the brains fixed for histology. Prior to MCA occlusion, lidocaine caused a statistically significant (p less than 0.01) reduction in the amplitude of the major cortical component of the SEP (10 +/- 1.2 microV vs 6.0 +/- 1.3 microV). Latency was unchanged. In the lidocaine group, SEP's persisted in 40 per cent immediately following occlusion whereas they disappeared in all of the control animals (p less than 0.05). Gradual recovery occurred in both groups and there were no differences at the end of the experiment although the amplitudes tended to be greater in the lidocaine group. There were no statistically significant differences in the histological size or severity of the infarcts between the groups. Although infarct size was not reduced, transient sparing of the SEP suggests that further studies of lidocaine by continuous infusion in models of temporary focal cerebral ischaemia may be warranted.

Effect of gamma-hydroxybutyrate on the reactivity of pial arteries before and after ischemia

The effect of gamma-hydroxybutyrate (GHB) on the reactivity of pial arteries to local metabolic factors was tested in chloralose-anesthetized cats before or after a period of transient ischemia induced by air embolism. The vascular reactions were determined during the perivascular microapplication of artificial CSFs with increasing concentrations of adenosine (10(-11)-10(-3) M), H+ (pH 5.1-7.6), or K+ (0-10 mM). During nonischemic conditions the pial arterial reactivity to adenosine and H+, but not to K+, was significantly increased by GHB (250 mg/kg i.v.) when compared with the control reactivity. After cerebral ischemia the reactivity to adenosine was abolished with and without the administration of GHB prior to air embolism. The reactivity to K+ was partly preserved but not increased by GHB when compared with previous results without GHB. In contrast GHB improved the postischemic reactivity to perivascular H+ that had been found to be abolished in previous experiments without GHB. The perivascular microapplication of GHB showed no influence of GHB on the vascular diameter. An important finding of the present study is the demonstration of an increase in cerebrovascular reactivity, which may give scope for therapeutic improvement of the regulation of CBF in pathophysiological conditions.

Cerebral embolization leads to memory impairment of several learning tasks in rats

The effects of cerebral embolization, produced by injecting microspheres into the left internal carotid artery, on passive and active avoidance tasks and water filled multiple T-maze task, were studied in male Wistar rats. The rats with cerebral embolization were markedly impaired acquisition and retention of the one-trial passive avoidance response. The impairment depended on the number of microspheres injected and continued for 2 weeks. The cerebral embolized rats were also impaired acquisition of two-way active avoidance response in a shuttle box. These impairments are not due to decrease in shock sensitivity, because there was no significant change in the flinch-jump threshold. The embolized rats also exhibited a significant disturbance in performance of water filled multiple T-maze learning. These results suggest that rats with cerebral embolization are impaired in three different types of learning tasks, and may be useful as an animal model for the vascular type of dementia.

Fluorocarbons: a potential treatment of cerebral air embolism in open-heart surgery

This study was designed to assess whether an oxygenated fluorocarbon solution could reduce ischemic brain damage related to arterial air embolism. Air embolism was produced by injecting air bubbles into the carotid artery of barbiturate-anesthetized rats breathing 100% oxygen. Results were assessed on electrocorticogram. In an additional set of experiments, mass spectrometry was used to provide continuous monitoring of intracerebral tissue oxygen (PO2) and carbon dioxide (PCO2) tensions and intermittent measurement of cerebral blood flow (CBF). Fluorocarbon or saline solution (containing the emulsifying agent of fluorocarbons) was given intravenously after the initial air embolism (0.2 ml), and injections of air (0.1 ml) were repeated thereafter every five minutes. The maximal amount of air required to achieve complete and irreversible flattening of the electrocorticogram was 1.60 +/- 0.06 ml (mean +/- standard error of the mean) in the saline-treated rats and 5.20 +/- 0.44 ml in the fluorocarbon-treated group (p less than 10(-7)). In the second experiment, air embolism caused CBF to rise in both groups, the average percent of increase being higher in treated (41.6%) than in control animals (38.3%) (p less than 0.02). However, in the control group, the increase in CBF did not prevent intracerebral tissue PO2 from decreasing by 7.4 +/- 7.0% over the same period; conversely, in the fluorocarbon group, PO2 levels fell by only 2.5 +/- 3.7% (p less than 0.001 versus controls), but this time-averaged percentage was calculated over a longer period of cumulative ischemia because of the greater number of air emboli tolerated by treated animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Protective effect of lidocaine in acute cerebral ischemia induced by air embolism

To investigate possible approaches to the prevention and treatment of neural damage induced by air embolism and other forms of acute cerebral ischemia, a model was used in which cerebral air embolism was produced by infusion of air (0.4 ml) into a vertebral artery of chloralose-anesthetized cats. Neurological function was assessed by measuring cortical somatosensory evoked responses in a group of 10 untreated animals and in a group of eight animals pretreated with intravenous lidocaine (5 mg/kg). In the untreated group, the primary somatosensory amplitude was reduced to 28% +/- 9% (mean +/- standard error) of the value before air embolism, with a return to 60% +/- 8% 1 hour and 73% +/- 12% 2 hours after embolism. In the group pretreated with lidocaine, the primary somatosensory amplitude was reduced to 68% +/- 9% of the value before air embolism, with a return to 92% +/- 3% 1 hour and 97 +/- 2% 2 hours after embolism. Pretreatment with lidocaine also greatly attenuated the acute hypertension and the increase in intracranial pressure following air embolism. These results demonstrate that pretreatment with intravenous lidocaine significantly reduces the neural decrement and increases the recovery of neural function after acute cerebral ischemia induced by air embolism.

Cerebral air embolism and the blood-brain barrier in the rat

Cerebral air embolism can have hemodynamic effects such as increases in blood pressure and cerebral blood flow. It has been suggested that these factors play a role for the induction of the blood-brain barrier (BBB) dysfunction. In the present study, 5 microliters air was injected into the right internal carotid artery from a catheter in the external carotid artery after ligation of the extracerebral branches. No consistent change in blood pressure was observed with this small amount of air. Hypercapnia, which increases protein leakage in the brain under conditions of high intraluminal pressure, significantly reduced the extravasation in air embolism. Lidocaine and SITS (4 acetamido-4-isothiocyano-stilbene-2,2-disulfonic acid disodium), two drugs that effectively reduce the albumin leakage in acute hypertension, had no prophylactic effect in cerebral air embolism. Spontaneously hypertensive rats are less vulnerable than normotensive rats to pressure-induced BBB dysfunction but did not significantly differ from controls regarding albumin leakage in the present study. It is concluded that the increased cerebrovascular permeability in air embolism is not related to hemodynamic factors.