Protection of focal cerebral ischemia by alkalinization of systemic pH

Robert E. Anderson, Fredric B. Meyer, Warren R. Selman, Robert J. Dempsey, Jeffrey M. Dembner, Gary K. Steinberg

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

OBJECT: It has been demonstrated in many studies that intracellular brain acidosis during cerebral ischemia is a significant factor in perpetuating the cycle of cellular dysfunction leading to neuronal injury. The purpose of this study was to determine whether preischemic administration of alkalotic agents could reduce neuronal injury after focal cerebral ischemia. METHODS: Fifteen fasted rabbits under 1.0% halothane anesthesia were randomized into three groups: Group 1 rabbits were ischemic controls (n = 5) that underwent 4 hours of focal cerebral ischemia. Groups 2 and 3 rabbits underwent a paradigm similar to that of Group 1, except that they were pretreated with either sodium bicarbonate or Carbicarb at similar buffering capacities. Intracellular brain pH (pHi), regional cortical blood flow (rCBF), and intrinsic reduced nicotinamide adenine dinucleotide (NADH) fluorescence were measured with in vivo fluorescence imaging. At the end of each experiment, infarct volume expressed as a percentage of hemispheric volume was measured by triphenyltetrazolium chloride staining. RESULTS: Preischemic alkalinization did not alter brain pHi, rCBF, or NADH fluorescence. After 4 hours of ischemia, brain pHi, rCBF, NADH fluorescence, and infarct volume measured 6.40 ± 0.09 (mean ± standard error), 11 ± 2 ml/100 g/min, 165 ± 8% of baseline control, and 37 ± 3% in ischemic controls, respectively. In Group 2 animals treated with sodium bicarbonate, brain pHi, rCBF, NADH fluorescence, and infarct volume improved significantly (P < 0.05, analysis of variance) to 6.74 ± 0.08, 24 ± 6 ml/100 g/min, 137 ± 6% of baseline control, and 22 ± 4%, respectively. Group 3 Carbicarb animals demonstrated improvements in brain pHi, rCBF, and NADH fluorescence, with a significant reduction in infarct volume. CONCLUSION: These findings suggest that pretreatment with alkalinizing agents may be a useful intervention to provide intraoperative cerebral protection from ischemic injury.

Original languageEnglish (US)
Pages (from-to)1256-1266
Number of pages11
JournalNeurosurgery
Volume51
Issue number5
DOIs
StatePublished - Nov 1 2002

Keywords

  • Focal cerebral ischemia
  • Intracellular brain pH
  • Neuroprotection
  • Systemic alkalinization

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Anderson, R. E., Meyer, F. B., Selman, W. R., Dempsey, R. J., Dembner, J. M., & Steinberg, G. K. (2002). Protection of focal cerebral ischemia by alkalinization of systemic pH. Neurosurgery, 51(5), 1256-1266. https://doi.org/10.1097/00006123-200211000-00022