1. Cardiopulmonary Bypass Increases Permeability of the Blood-Cerebrospinal Fluid Barrier 
Toru Okamura, MD, Nobuyuki Ishibashi, MD, David Zurakowski, PhD, Richard A. Jonas, MD 
The Annals of Thoracic Surgery 
Volume 89, Issue 1, Pages (January 2010)
DOI: /j.athoracsur
Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
Introduction of the catheter into subdural space. The piglet was placed prone for inserting an epidural catheter, which was used to draw the cerebrospinal fluid intermittently from the cisterna magna. A small pillow was placed under the shoulder to facilitate flexing the neck. After the midline of the occipital and cervical area was opened and the atlanto-occipital membrane was dissected, the dura mater of the cisterna magna was found. A purse-string suture was placed on the dura mater. An epidural catheter was gently inserted under that membrane, without any blood contamination, and was fixed to the dura mater.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
(A) Changes of pH in cerebrospinal fluid (CSF) for all cardiopulmonary bypass (CPB) groups. Levels for both 15°C and 25°C hypothermic circulatory arrest (HCA) groups were significantly lower than the control group. The pH of both HCA groups at 115 and 160 minutes was lower than the other three groups. *p < 0.05, repeated-measures analysis of variance (ANOVA). (p-30 = 30 minutes after the end of cardiopulmonary bypass (CPB), p-120 = 120 min after the end of CPB; FF = fast flow; LF = low flow.) (B) Changes of partial oxygen pressure (Po2) in CSF for all groups. Po2 of both HCA and 25°C, low flow (LF) groups was significantly higher at 50 minutes than in others. The values of both HCA groups were higher at 115 minutes than in others. *p < 0.05, one-way factorial ANOVA. (C) Changes of partial carbon dioxide pressure (Pco2) in the CSF is shown for all groups. Pco2 levels in the bypass groups were significantly higher at 115 minutes than in the control. The values in both HCA groups were significantly higher at 115 minutes than in other bypass groups, *†p < 0.05, repeated-measures ANOVA. Error bars show the standard deviation.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

4. Fig 3
(A) Changes of lactate levels in plasma are shown for all cardiopulmonary bypass (CPB) groups. Lactate levels in 25°C with low flow (LF) and both hypothermic circulatory arrest (HCA) groups were significantly increased compared with control. *p < 0.05, repeated-measures analysis of variance (ANOVA). (B) Changes of lactate levels in cerebrospinal fluid (CSF) are shown for all groups. Lactate levels in both HCA groups at 115, 160, p-30 (30 minutes after CPB) and p-120 minutes (120 minutes after CPB) were significantly increased compared with others. *p < 0.05, repeated-measures ANOVA. Error bars show the standard deviation.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

5. Fig 4
Albumin quotient (QAlb) of cerebrospinal fluid/plasma is shown for experimental cardiopulmonary bypass (CPB) groups at each time point. Error bars denote standard deviations. Asterisks indicate higher QAlb (reflecting greater permeability) compared with 37°C fast flow (FF) and 37°C off (control). *p < 0.05, analysis of variance with Bonferroni correction. QALB in 25°C hypothermic circulatory arrest (HCA) was higher than 25°C low flow (LF) at 115 minutes (p = 0.03), 37°C FF at 115, 160, and 190 minutes (all p < 0.01), and 37°C off (control) at 115 minutes (p < 0.01), 160 minutes (p < 0.01), and 190 minutes (p = 0.03).
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions