Evaluation of the correlation of change in cerebral NIRS levels and renal functions of pulsatil and nonpulsatil extracorperal circulation in elective coronary artery bypass graft surgery cases

Acute renal failure is a significant cause of morbidity and mortality after CABG surgery. Functional NIRS is a method of demonstrating brain perfusion. Cerebral NIRS is more correlated with renal function than somatic NIRS measured over the kidney. This study aimed to investigate the effects of pulsatile and non-pulsatile flow on renal functions with cerebral NIRS. In our study, the correlation between the changes in cerebral NIRS levels of pulsatile and non-pulsatile ECD and renal functions in patients who will undergo CABG operation in Tekirdağ Namık Kemal University Faculty of Medicine, Department of Anesthesiology and Reanimation was evaluated. Fifty-two consecutive patients who underwent isolated coronary artery bypass surgery with similar preoperative renal failure scores were prospectively included in the study. Pulsatile perfusion (Group I) was applied to 26 patients, and non-pulsatile perfusion (Group II) was applied to 26 patients during the cross-clamping by simple randomization method. Demographic characteristics of the patients [age, gender, body mass index (BMI), co-morbidities, operation, PCC (aortic cross-clamp time) and perfusion times], hematological and biochemical parameters [preoperative and postoperative; urea, creatinine, preoperative and perioperative; from arterial blood gas (ABG) analyses; PO2, PCO2, sPO2, Na, K, base deficit, hematocrit (Hct); preoperative renal failure scores and perioperative NIRS values were compared. Urea and creatinine values were not statistically different between Group I and Group II and between preoperative and postoperative periods. It was statistically significantly higher in both groups in the postoperative period. NIRS measurements differed between Group I and Group II at baseline, 20th min, 40th min. Values between them were found to be statistically insignificant. 20. min. in both groups. And 40. min. was found to be statistically significantly lower than baseline. PO2 measurements Group I 20. min. 40. min. Measurements were statistically significantly higher than Group II. PCO2 measurements were found between Group I and Group II at baseline, 20th min, 40th min. values between them were found to be statistically insignificant. SPO2 measurements Group I 20th min, 40th min. measurements were found to be statistically significantly higher than Group II. K measurements between Group I and Group II at baseline, 20. min, 40. min. values between them were found to be statistically insignificant. 20.min. in both groups. and 40.min. was statistically significantly higher than baseline. Na measurements Group I basal, 20. min., 40. min. measurements were statistically significantly higher than Group II. 20.min. in both groups. and 40.min. was found to be statistically significantly lower than baseline. B.E. measurements Group I 20. min. measurements were statistically significantly higher than Group II. 20.min. in both groups. and 40.min. was found to be statistically significantly lower than baseline. Hct measurements were between Group I and Group II at baseline, 20. min, 40. min. values between them were found to be statistically insignificant. 20.min. in both groups. and 40.min. was found to be statistically significantly lower than baseline. It was determined that there was a statistically significant relationship between total pump time and NIRS change rates (20.min.-40.min.). It was observed that there was no statistically significant linear relationship between NIRS percent change and Urea and Creatinine percent change. A statistically significant correlation was found between the percentage change in NIRS (baseline-40. min) and the percentage change in PCO2 (baseline-40. min.). The total pump urine and UF application were statistically significantly higher in Group I than Group II. It was concluded that oxygenation is preferable to non-pulsatile flow in the pulsatile group due to its positive effects. The pulsatile flow was significantly higher in extracorporeal circulation in terms of urine volumes. UF requirement was higher in nonpulsatile flow during extracorporeal circulation than in pulsatile flow. We think that the positive effects of pulsatile flow in terms of microcirculation are better than nonpulsatile flow.